the phrase I TOLD YOU SO comes to mind

nursing dilemma: fall into bed exhausted, or fall into bed exhausted after drinking large glass of wine?

i told the powers that be that we needed another tech, but nobody listens to me. apparently they want you to feel like you're participating in staffing choices by making you the charge nurse, but they don't actually want you to make any decisions or (heaven forbid!!) voice an opinion. so we had 1 tech tonight, 1 tech for 19 patients which i'm told is "appropriate staffing". 1 person is supposed to get vitals and fingersticks on 19 people? to take them all to the bathroom, and bring them waters, and count the intakes and outputs? to answer the call lights and clean up messes and change sheets and help turn? as fabulous as our tech is and as hard as she works, this is just not possible. but the (holy, almighty) staffing matrix says we don't get a second tech until we have 20 patients.

which is why after we got our first (of several, thank you very much) admits, i went to the powers that be and said "so we got an admission, where's my tech?"

in hindsight, that may have been inappropriate.

long story short, there was no tech. but there was another admission, then 2 more on the night shift. it was about this time that we realized that our second tech for nights never showed up to work.

then my admission rolled in at 2130 and i couldn't get anything done with her until the police finished grilling her about how she got stabbed.

so here i am, finally home after punching out almost an hour and a half late. i'd like to think of it as "revenge overtime".

should have given me that tech, hmm?

i don't think i need the wine tonight. i've got my righteous anger to keep me warm.

there are dollar signs where our hearts should be.

my heart breaks a little today, as i just found out that my favorite trauma nurse clinician's position is being eliminated in february. frankly, i'm getting more than a little bit tired of working for an organization that obviously enjoys showing nurses just how little they are valued.

it's ok with "the man" that i am verbally threatened by my patient's family. in fact, it is actually MY fault.

it's ok that i have to walk a half mile in the dark/freezing cold past the mental institution to my car at night.

it's ok that we constantly work short, with equipment that doesn't function.

it's ok to take the best resource that we have as nurses (aka our trauma nurse) away from us. It's not like she's the only one on the service that knows what's going on...oh wait, SHE IS.

i think we should change the motto of the organization to {enter greedy hospital name here}: you are replaceable.

why on earth would the hospital eliminate the person who mediates between doctors and nurses and makes us see each other as people? why would they take away the individual who can build a relationship with even most soulless of patients? why would they get rid of the nurse who has the skills to see when there is something wrong with a patient and the power to actually DO something about it. i'll tell you why

$$$

that is the only reason. and that makes me sick.

so we saved a life before 1500

nothing good starts with the sentence "I don't like the way my mom is breathing". of course i would have to be the one to answer THAT call light...so i sent the nurse down to the room to see what was going on. she came out a few minutes later reporting that the patient was breathing at 8 a minute. not good, not good at all. she grabbed a vial of narcan to reverse the narcotics the patient had gotten earlier and i went to page the doctor. i looked everywhere for the patient's chart to find what resident was taking care of her and couldn't find it, so i just sent out a general page through the operator and went in to help. the nursing student got vitals, which showed that the patient's O2 sats were 78%. my coworker started pushing the narcan and i ran to grab a face mask and put the patient on 10 liters of oxygen. less than a minute later, the patient's sats came up to 100% and she woke up, thanks to the miracle of narcan. we titrated her O2 down to 3 liters and the nursing student stayed with her to take more vitals. it wasn't until this point than the doctor called back. apparently i paged the attending.

oops.


i could tell that things weren't going too well...the nurse was having to explain herself way too much and there appeared to be some lecturing going on. the attending told her that he didn't feel comfortable telling her that it was ok to give the narcan, and he needed to look up the policy. to which i say:

SERIOUSLY?

giving narcan is within our scope of practice. and when i see a patient who is struggling to breathe, turning white, and looking like she's headed to heaven i will give my narcan and have no remorse. feel free to look up the policy, because i'm pretty sure that it won't say that we should let little old ladies die while we wait for you to return my page.

five minutes later the attending called back. he looked it up and had decided that we were indeed allowed to give the narcan. gee thanks. oh, and YOU'RE WELCOME for helping your patient live to see another day.

well THAT'S a new one.

So my patient got hit by a car. He refused medical treatment and instead went to the bar. When he was done at the bar he realized that he couldn't walk so instead crossed the street on his butt. Then he got hit by another car.

1. stop drinking
2. don't sit in the street

Make good choices, people.

entitlement

people think that they deserve special treatment all the time, and it makes me crazy.

case in point:

we get a GSW patient from the OR...should have known it was going to be a disaster when the PACU nurse said that she had 30 family members in the waiting room. (for the record, THIS IS NOT OK!! you have no business having three dozen people in your room. this is a hospital, not a club.) so the family comes up and for awhile everything was just fine. i was running back and forth through the nurses' station when i saw one of the family members barfing into our garbage can...and by that i mean on the floor, on the secretary's desk, and on the paper shredder. i actually gave this woman the benefit of the doubt...figured maybe she had gotten all emotional and got sick. so i got towels and some bleach wipes and attempted not to gag as we tried to clean up the food chunks off the floor. (ok, so when you come to the hospital, YOU ARE NOT THE PATIENT. i do not owe you buckets to barf in. i am not getting paid to clean up your puke. and i certainly do NOT think it's ok for your to throw up on our carpet and then blame it on us because "that aide didn't bring my bucket fast enough.)

we came to a consensus: sick visitor needs to go home. so our charge nurse approached her and gently suggested that she leave. the visitor was quick to say that she wasn't sick, she was have a procedure tomorrow and was taking a bowel prep that make her throw up. (oh dear, there are so many things wrong with this....first of all, WHAT ARE YOU DOING HERE? bowel preps make you poop your brains out. go home and sit in your bathroom like a normal person. who goes to the hospital swinging their bottle of golytely around? it's just freakish.) the RN still thought that she should go home, but the visitor was not receptive to this and started yelling that we would have to throw her out. (to which i say...ok!!) the charge nurse was getting nowhere with this woman so she just walked away.

i'm going about my business doing meds in the front hall when the barfy visitor and her family posse walk by. she's talking loudly about how "that nurse think she all hard" and i knew we were going to have a problem. as the family walked by, a male visitor got right up in the charge nurse's personal space as she was talking on a hall phone. he sniffed really loud like he was going to spit at her. the woman visitor took this opportunity to throw the barf bucket at the nurse's feet and says "i don't need this anymore". (oh NO YOU DID NOT JUST. first of all, intimidation and harassment, much? and don't you dare think for one minute that i'm going to put up with that just because i'm at work. you DO NOT get to treat people that way, you WILL NOT get away with that behavior, and i WILL call security and the sheriff on you and laugh gleefully as they take you away).

well the RN handled things much as i would have and, shall we say 'deflected' the bucket back at this lady. the visitor picks up the bucket and raises it above her head to throw at the nurse...and i just snapped. i charged down the hallway waving my finger at this woman and yelling "you do NOT throw things!! put that down, this is a hospital!!". the woman and family quickly began to blame things on the nurse, calling her unprofessional and going on and on about how they were going to report us. things were escalating quickly, so i called security. the woman is standing in the middle of the hall yelling "call them, i stand right here...I'LL STAND RIGHT HERE" while throwing her purse at a family member so she can "beat your MFing asses". i'm trying to hold back the nurse who's not backing down, and stepped between the visitor and the nurse, basically just waiting for someone to start ripping hair out. by this time i'm yelling "get out. go. GO!!" at these people and now more of my coworkers are coming down and trying to get both of us to walk away. security finally came up and carted the visitor away. i then had to type up a written statement of the incident. as livid as i was, i ranted for awhile and then just finally sat in the back room and cried until i felt better.

so let me recap:

this is all the hospital's fault because we didn't get the visitor her bucket in time so she had to throw up on the floor. it's her right to be here as a visitor and demand nursing care, hospital supplies, as well and gum and mints from all of us. since she didn't want to go home she can yell and scream at people so she'll get her way. When that doesn't work, she can have her family members intimidate staff and then throw things at them. When that is not well received, she can scream in the middle of the hall and disturb sick people who are trying to rest. to get her point across she can call names and threaten staff. she's not finished until she's carried away by the sheriff and given a ticket for being "disorderly" that she will probably never pay. and as the real punishment for all of this, she isn't allowed to visit for 24 hours...but don't worry, she CAN come back!! because after all, visitor's have rights.

it's apparently just the nurse's who don't.

i'm WAY over these selfish, entitled, hateful people.



*UPDATE*
the visitor in question called to lodge a complaint against us. then we had to sit through a debriefing in which this entire situation was blamed on the nursing staff. in the future, we will be looking forward to some "de-escalation training". i have the following things to say:

1. bitch please.
2. this is a hospital, not a department store. the 'customer is always right' rule does not apply here. not to mention the fact that YOU ARE NOT MY CUSTOMER. you are my customer's rude, classless family member who's barf i just had to scrape up off the floor. you're welcome for that, by the way.
3. i'm pretty sure i'm going to start strapping a shank to my ankle. can't be too careful these days.

how rude.

being a nurse is pretty much like being a glorified punching bag. you don't like that you're in the hospital? be rude to your nurse. you're mad that you're in pain? yell at your nurse. you're upset with the doctor or the plan of care? go ahead, take it out on your nurse. after all, i am the source of your troubles, right? the reason you're in the hospital? the cause of your pain? oh wait a minute...i'm the one who cleans up your poop and brings you pain meds and smiles at you when i'd just as soon rip your face off. but go ahead, be mean. i mean it's not like i'm a real person, after all. i'm a nurse.

newsflash: I HAVE FEELINGS TOO!!

honestly, most days this stuff rolls off my back. patients are a little snippy? i can win over most fairly quickly. i'm pretty darn patient, and after almost three and a half years of being a nurse, i've gotten a pretty thick skin. but i have NEVER had a family member talk to me the way that a patient's sister did tonight.

icu transfer. altered mental status and an open abdomen. status quo. the patient was weird but otherwise fine. the patient's sister would have made the devil himself cry. i'm ashamed to say that it was a 75 year old lady with a skirt pulled up to her boobs that finally did me in. i first knew that we were going to have a problem when the sister found me at the nurses station and accused me of not giving my patient pain medications. we had a lovely conversation in which she essentially accused me of neglect and i threatened that if i gave too much narcotic the patient would stop breathing. she had the audacity to yell at me, but i managed to barely hold it together. being the professional that i am, i internally vowed to give her the silent treatment for the rest of the evening as punishment for being so evil.

i actually thought that i was home free, and that was my first mistake. we had made it to the end of the shift and i had been in the patient's room 45 minutes earlier to get her repositioned and settled for nighttime. she was comfortable. so i went to do about 234234 other things with my other patients. i was sitting down to give the night nurse report when the sister came up to the nurse's station. she was once again raising her voice with me and ridiculously rude. she dared to say that her sister was overdue for pain meds. EXCUSE ME. what part of pain medications are not scheduled do you not understand? and if you're in the room with your sister and she needs pain meds, why wouldn't you simply put on the call light and ask for them instead of coming up the the front desk to alienate your sister's nurse? have people no understanding of this simple concept? let me spell it out:

if you make me hate you, i will try to avoid you. simple as that.

so i went down to the patient's room so the sister would stop yelling at me in front of all of my coworkers. and what did i find? a very comfortable looking patient with her eyes closed. resting. and did she ask for pain meds? only after i brought the subject up. of course her sister took this opportunity to continue to berate me and accuse me of not following through. i made one last ditch effort to be civil, then decided to stop wasting my breath.

"I DON'T KNOW WHAT ELSE YOU WANT FROM ME!!"

that's right, i said it. and i'd say it again.

people have no boundaries at all. what gave her the right to yell at me for trying to help her sister the best way i know how? the patient is HALLUCINATING ELVIS. the last thing she needs is to be snowed on narcotics. i will give my patient medication to control HER pain, not to make her sister feel better/validated/like she's being a good advocate.

so at this point, i realized that i needed to remove myself from the situation and handed over care of the patient to the night nurse. apparently he wasn't quick enough for the sister, who went on a rampage. she walked into an occupied room to search for linen, then yelled and swore at one of my coworkers who tried to help her. all the while, she cursed my name and demanded to talk to a supervisor.

i don't care that she was old as god and looked like a librarian. lady needed to learn some manners. so i called security and they escorted her out.

even nurses have limits, people.

it's not a full moon. i checked.

...but you would think so from the clientele we've got this week. The highlight of tonight was the guy who insists on wearing an isolation mask and gloves and makes capes out of the bed underpads. He is frequently found in the hall attempting to make phone calls from the hospital phone. He enjoys moving the wet floor signs to the middle of the hallway and attempting to read his own chart. Other pass-times include ripping down all the papers on the inside of the chart cabinets and rifling through the phone book in an attempt to call a cab to leave. I think that he's brain injured as half of his head is shaved, but something about the way that he rants on and on about the president getting assassinated smacks of schizophrenia. Said individual went on the warpath around 9 pm and was discovered in his room throwing butter knives at his one to one sitter. As the staff felt threatened by his violent behavior, they closed the door to his room and held it shut so no one would get hurt until security arrived. This all attracted the attention of a doctor from across the hall who opened the door to the cabinet outside the room so he could talk to the patient. I unfortunately missed this entire exchange, but the thought of this particular doctor talking to this crazy patient through a secret passage makes me giggle with glee. End result? The patient was restrained until he calmed down. And I laughed until I cried.

{yawn}

NG tubes that don't work right are a special kind of hell. I just spent 10 hours watching my poor patient vomit through his wired jaw while praying that he wouldn't aspirate. He's exhausted. I'm exhausted. He has a new NG tube. I have a headache. Here's hoping for a better day for the both of us tomorrow.

in the beginning...

i recently came across this little gem from about a year after I had started nursing. it's funny to look back and see how i would handle things differently now. also how some things never seem to change. without further ado:


Why this week was the worst I have ever had, a litany:
o Milk and molasses enema…need I say more? I actually had to stir together milk and molasses, heat it up, pour it into an enema bag, and spend AN ENTIRE HOUR waiting for rock hard stools that I had to attempt to pull out of my patient. And then the next day, I got to do it AGAIN with a soapsuds enema. Fabulous.
o I have a big mouth that I can’t keep shut. I did an impression of a new resident, accent and all, that he overheard. So for the next year, I owe him, and he will probably hate me.
o Dr. {name removed to protect the guilty}. He is Irish. He is hot. But he has zero bedside manner. First he told me that I had to do an inappropriate discharge, then he alienates a family by talking down to a patient’s wife who has been a nurse practically longer than I’ve been alive. And who gets to deal with the aftermath of this? Me. Thanks.
o Above mentioned inappropriate discharge…my patient was 23. Pregnant with a perirectal abscess. Two other kids at home. No support system. Admitted for pain control. We kind of controlled her pain, then sent her home on the exact same meds she was on before that didn’t work. Had been back and forth to the ED every few days for the past two weeks. Was admitted as an Obs. patient, and had spent a day with us in which NO ONE DID ANYTHING TO HELP HER, and then she was dumped on me. She needed a social worker, she needed better meds, she needed a lot of things which I was unable to give her, and when I shared my concerns with Dr. {McMeanie}, he implied that he knew her, I did not, she is psychotic, and I should fall in line and do what he says.
o Families from hell. All week long. Demanding, rude, demeaning. Three out of four patients had medical people at bedside. I was referred to as “nurse” and ordered around by an orthopedic surgeon from {town an hour away}. He demanded I call the senior resident, because “he’s in house, and can stop banging the nurses to come talk to us”. Later, this patient’s son tells me, in a nutshell, that I don’t care about his mother and asks if I would treat my own mother this way. Leading me to-
o Yes, I cried in front of families this week. Twice. Once when Dr. {jerk jerk jerk} was rude to my patient’s wife and once when I was being chewed out for not emptying a hat in the toilet.
o ICU disaster…I transfer a patient upstairs for respiratory issues. He’s on 7 liters on a CPAP and is desating. He can maintain his sats only if his family sits at his bedside constantly and convinces him to cough and deep breathe. He doesn’t want to do this, because he just wants to die and is upset we keep “resuscitating” him. We have him up to 15 liters on the CPAP, at which point he is apparently sick enough for the unit. Of course he starts looking real good the second we start to transfer him. And by the time I get back downstairs, after working through my lunch, of course, the ICU is on the phone saying they’re going to transfer him back.
o At this point, I am done. I begin to cry, then sob, then hyperventilate. I breathe so fast that my lips turn numb, and I realize that not only am I coming off as a total crazy, but that if I don’t stop soon I will probably pass out. Such was my very first anxiety attack. And that was my week.

names have been changed to protect mahself from being sued and/or terminated. however details are in their original form, including my very embarrassing breakdown in the back room in front of a half dozen coworkers. i read this and i think:

THANK GOD the days when i would just cry cry cry all day long at work are over.

THANK GOD i've been growing a backbone to stand up to mean and arrogant doctors.

and THANK GOD i'm not a new nurse anymore.

seriously, if i would have known it would be that bad, i probably would have run screaming in the other direction. but i had no clue, and now here i am 2 years later WAY more prepared to do my job. and also more mentally stable :)

amen.

'trauma season'

opportunities for blogging have been few and far between this summer. partly because i'm concerned my words will be used against me, partly because nothing seems strange to me anymore and partly because i've been exhausted. summer is notorious for being crazy. it's the time of year when people fly into rages because they're so hot, drink too much, and ride various wheeled things without helmets. summer is always full of trachs, chest tubes, and (my fave...NOT) road rash. so here's the summer in a nutshell:

19 year old gentlman with a GSW. he's a familiar face because he also got shot last year and was on the unit. he goes off for surgery one day, and his fiance and baby mama take the opportunity to throw down. the day RN kicked them off of the floor, so they continued their business at the bus stop. as a result, the fiance was banned from the hospital for 24 hours and the baby mama got her car towed and can't ever come back. i spent the rest of that shift on the look out for the offenders. unfortunately the only physical description i had were "has fake eyelashes" and "wears really short shorts". this does not really narrow things down.

40 something with some mental health issues...tried to commit suicide in several ways and didn't. she got up to go to the bathroom and suddenly became all grey and catatonic. we got her back to bed and she still wouldn't respond to us. we paged our MDs 3 times without success, so i stalked them in the trauma bay (as i learned was expected of us here. i got a less than helpful nurse who informed me that there was a trauma alert (ask me if i care. do i care? NO.) and hung up. she called back 2 minutes later to pass on a message from the trauma team: call a code and call the ICU resident. well lets all step back a minute here and think about this. did i say the patient wasn't breathing? that she was pulseless? and really people, if the patient were coding do you think i would walk away and ask the doctors what i should do about it? girl, please. so anyways, i didn't call a code, the ICU resident came down, and the patient was whisked away to the CT scanner. the trauma team never came up to see her. the intern, however, did call back after everything was done to drop a few F-bombs and criticize our management of the situation. so there's that.

my summer project: a middle aged diabetic with necrotizing faciitis...basically flesh eating bacteria. because he didn't manage his blood sugars, the bacteria tore through his left leg and groin. the doctors went in and removed the dead tissue down to muscle and vessels. he's been on the floor for 2 months with surgery after surgery to try to repair his leg. now i'll admit, at first i wasn't a fan. he was constantly on the call light and i never got to him fast enough for his liking. he was always farting and burping, peeing on open wounds or calling for the bedpan. he liked discussing his bodily functions in exquisite detail and scratching his man-parts. i won't lie, he utterly repulsed me. but after a while, i got to see the person underneath all the grossness. and as i took care of him more, i found an average guy who just wanted to live a normal life. he uses walkie-talkies at walmart to talk to his girlfriend. he sells vintage lightbulbs on Ebay. he knows how to fix cars. inside he's a gentle man who just wants to go home to his girlfriend, their cats, and his simple life. i won't lie, sentimental fool that i am it breaks my heart just a little. and it's always a good reminder for me: people are just people.

so trauma season is drawing to a close...i'm a little sad because it's my favorite time of year, and i creepily enjoy picking gravel out of people. oh well, there's always next year.

confessions.

these things happen from time to time. the nights where i can't seem to complete a task. when nothing goes right, when i'm off my game and i leave work feeling completely and utterly defeated.

geez it is HARD having a type-A personality. i want everything to get done, done right, and done on time. i want everyone to like me. i want my patients to be clean, pretty, and healthy, i want the doctors to love me and trust my judgement. i want to be admired by my peers and respected by everyone around me.

HA.

instead i am constantly frazzled, running around like some sort of schizophrenic person. i mumble to myself as i walk, a combination of things i have to do and prayers to jesus to make the mess of my day better. most nights i feel like i'm neglecting my patients, because i never see them as much as i want to. there is always at least one desperate plea aimed at an aide to "please go see room --- and make sure that they're still alive because i haven't been in there in hours". my coworkers must think i'm absolutely insane, because i go onto tirades about injustice on a daily basis. the doctors want to steer clear of me because they don't want to hear my obsessive theories about what's wrong with their patients. my meds are always late, my charting is never as complete as it should be and yesterday i totally forgot to write out my report sheets AND i didn't do careplans. i almost always punch out at least 45 minutes late, and then i drive home only to remember several things that i forgot to do. my patients are never walked as many times as they need to be, i don't do IS with them every hour and sometimes i don't make them wear their SCDs. and i don't think that any of them ever brush their teeth which i think about all the time but am always too busy to ask. i'm horrible at prioritizing, i really don't know where any of the 'time' in my 'time management' goes, and almost every task takes me at least 3 trips in and out of a patient's room.

but before someone tries to take away my license...

i care about my patients. i give 100% even when that's more than i have to offer. i try to practice with prevention in mind. and i believe that making my patients feel comfortable is more important than giving them their meds on time or doing all of their paperwork.

so tonight, that's going to be enough for me.

i feel your pain

i've been coming face to face with some tough stuff this week. last sunday i learned that a younger guy who i go to church with has a brain tumor. for some reason, this hit me especially hard, even though we're only acquaintances. fortunately, he's had surgery and is doing great. i'll be honest, i was glad that everything was pretty much over so i could get rid of the pit that's been in my stomach ever since i heard about his situation. however tonight i was shocked to learn that ANOTHER guy, someone i was involved with in college, was recently diagnosed with a brain tumor and will be having surgery next week. though we're not close, this also makes me feel sick.

i'm feeling the weight of dealing with this as a nurse as well as a peer. when anyone your age has to face something like this, it's pretty jarring. there's always the "he's so young" and the "it could be any of us" and the worry that comes when you get to thinking about what could be lurking in your body that you have no idea about. but when you're a nurse, it's different. you don't get to ask why or get upset, sick people are your job. you don't get to wonder how this happened or ask questions, people expect you to have all the answers. you're not supposed to get scared, despite the fact that you know waaaaay too much not to be terrified.

people get sick everyday, this i know. well people get into accidents, some of them are irreparably damaged. but when it's "my" people, it's different. when i can say "hey that guy leads singing" or "i kissed him when i was 21" it's real. this is the same feeling i have when i take care of palliative patients. the fact that someone can be here one minute and gone the next continues to boggle my mind. how is it possible that i have to deal with this in my 20s? because surely other people my age have cubicles and are thinking about happy hour, not calling a patient's husband to come to the hospital because i just held his wife's hand while she died.

this is not what i signed up for, yet no one really seems to understand that. the general consensus is "you're a nurse, this is what you do, you should be about to handle anything". therefore i'm not really supposed to get upset about patients because they're only my job. well i can tell you right now, not getting emotional isn't my strong suit. i take things personally. i can't leave work at work, i have never been able to and i don't plan on starting anytime soon. it's part of what makes me a good nurse, but all that empathy really takes its toll. this week i had a patient in pain and i COULD NOT get it under control no matter how hard i tried. i gave her narcotics, i gave her nausea meds, i gave her GI cocktails. i called the doctor and got her meds increased, then i called him back 10 minutes later and got the meds changed altogether. nothing worked. she was crying, rocking back and forth in her bed and there was NOTHING i could do for her.

so i went in the back room and i cried. because watching people suffer and being powerless to change what is happening to them hurts.

so maybe that's why i'm so upset by the brain tumors. because the nurse in me wants to make this better, but both situations are out of my hands. and, in case you can't tell, giving up control is also not my strong suit.

disclaimer, part 2

unfortunately, i've learned the hard way that people will use just about anything against you to prove a point. i've recently had some issues with social media...long story short, i may have accidentally offended some people by talking about work.

actually, that's a lie...i got caught in the crossfire of two grown women acting like teenagers and got put on probation for several very nondescript, non hipaa-violating comments that were discovered during their adolescent fighting.  i never actually violated the social media policy, but was still punished for it.  apparently large, powerful hospitals need scapegoats to keep all the little people in line, and i was lucky enough to get to fill that role.  

for the sake of clarity, i'd like to say a few things.

to state the obvious, the views and opinions expressed here are those of my own and not of my employer (duh). i don't speak for anyone but myself, and surely we all know that i'm just a touch biased with these stories :)

for the record, i work at a very good hospital with very good people. while some of my stories may highlight my frustrations, there are plenty of other fabulous things about work that i don't blog about. overall, i think that my place of employment provides great care, otherwise i (obviously) wouldn't work there. the issues that i have with doctors, patients, and really the hospital environment in general are pretty universal. i may rant and rave like a crazy person on a regular basis, but should i ever be in need of care i wouldn't hesitate to use my employer.

so to sum things up, i am taking a risk by continuing to blog. but even though other people might think i'm crazy, to me it's worth it. there is a type of satisfaction here that i'm not ready to give up. and frankly, i think it's pretty great to look back on the situations i've been it over the past year and see how far i've come.

so i'm going to continue. because if there's one thing that being a nurse has given me, it's a backbone. i spend most of my days advocating for my patients, now it's time for me to fight for myself.

cause we're not having fun until somebody is bleeding out

this week on my list of mortal enemies: the ER. the ER has certain habits that drive me crazy. for example, they frequently send their patients up to the floor naked, usually bleeding, and often with empty IV bags dragging behind them. so today when i got a stab wound to the chest from the ER, i was not surprised to find him pretty much as described above. the MDs had put in a chest tube, and i was taken aback when i saw that it had already put out about half a liter of blood since it was placed. i got the patient settled with another nurse and we pulled off the dressing that was leaking blood everywhere to put a clean one on.

still bleeding.

i called the doctor and told her how much blood was in the cannister...now about 600ccs. she told me to start fluids and she'd come see him. i did his admission.

still bleeding.

850ccs. paged the doctor again. she called back. now 975ccs. she said she'd call her attending and that we'd make him nothing by mouth for possible surgery. at this point the patient began yelling at me that he wanted dinner.

still bleeding.

the blood in the chest tube was now in the second chamber, so over a liter. vitals still ok. patient still yelling "i shouldn't have even come here" because i wouldn't give him his dinner tray. and finally, the bleeding seemed to slow down. 1130ccs. i took some vitals, and he was still ok. he fell asleep, and i let him be.

20 minutes later i'm (miraculously) seeing another patient when the doctor came in. apparently they had seen the patient and taken his blood pressure. 70/42. suddenly there was a sense of urgency. we needed fluids wide open, a type and cross for 4 units of blood and to get the blood right then then give it. all while getting pressure bags for the fluids and getting the patient hooked up to the dash monitor. um, not going to happen. i basically got as far as the fluids before the doctors started to yank the cords out of the wall so we could take the patient to OR. i managed to get one final BP in before that too got disconnected: 65/40. cue panic.

every once in awhile, the hospital really is like tv. and if i've ever felt like i'm on primetime, it was tonight as i ran down the hall towards the OR with a pressure bag in one hand and the other hitting the patient to make sure he was still alive. how we made it to the OR in one piece i will never know, but there i was under the bright shiny intimidating lights. the next thing i knew everyone was gowned and gloved and i was feeling very conspicuous. someone handed me a hat and mask, at which point i made my exit. frankly the OR freaks me out...way too clean and you can't touch anything in there...so that was that.

i honestly expected the patient to come back to the floor, but he got an ICU bed. when i took his belongings up, he was intubated and looked like a hot mess. and to think, 4 hours earlier he was stable enough to come to the floor.

so do i blame the ER for this? not really. they didn't really see the patient bleed all that much. and do i blame the doctor? she was actually pretty on top of things. and do i blame myself? no way, i rocked this one :) i kind of feel like this is just one of those things that happens...hopefully the patient will return to the floor no worse for wear and grateful that we helped him.

but for the records: it wouldn't kill the ER to throw a gown on a patient every once in awhile. sheesh.

patients: hazardous materials? i think yes.

let me begin by saying that i should be making some sort of hazard pay. as a trauma nurse, patients try to beat me to a pulp on a regular basis. I've been scratched across the chest, pinched, had patients try to bite me, been kicked at, had people try to punch me in the face, been screamed at, sworn at, and called every name you can think of and some things you can't including an "f-ing bed whore"...seriously, what does that even mean? tonight was no exception.

it all started when i answered the call light...come to think of it i really should stop doing that. the woman on the other end was frantic. her son was having a seizure. so i gathered the other people in the nurse's station and we ran down to the room to find the patient seizing. we all did what you're supposed to do in a seizure, which is basically nothing. we watched the patient so we'd know what happened during the episode and kept him safe. for this particular patient, that meant putting his helmet on. he had recently had brain surgery and they'd taken out a piece of his skull. this means that he has his brain, then some skin, then the outside world. so on went the helmet, he stopped seizing after a minute or two, and we all thought we were in the clear.

haha.

of course after this seizure, he was confused. he kept grabbing at his oxygen and trying to rip the helmet off his head. his O2 sats weren't great, so i held his hands down so he couldn't get at the tubing. and needless to say, we didn't need the man with the exposed brain to start thrashing around. we kept him calm for a little while, but then he started to fight us. the more we tried to hold him, the harder he pulled away.

so i called for reinforcements.

then there were seven or eight of us trying to hold him down, and it still wasn't working. now he's screaming and thrashing at us. i unfortunately didn't have gloves on and couldn't let go to put on a pair, so he was trying to scratch me. when he still couldn't get free, he started kicking and biting. at this point we're yelling for restraints and i'm frantically calling for more help. we called a rapid response, then security to the floor. it seemed like FOREVER until the oldest security guard we have who must be at least 75 showed up. by this time we had respiratory therapists in the mix and the patient was almost totally restrained, but still clawing at people. it's kind of fuzzy to me when I finally gave up trying to hold him down, but i think it was around the time that i realized i was bleeding.

great. just what i need in my life, another incident report with my name on it.

the casualties included 4 people with claw wounds and 1 very unfortunate nurse with a bitten thumb. we all declined the trip to the ED, but there was free antibiotic ointment for all for our efforts. the patient eventually calmed down, after 4 mg of ativan and all of his extremities tied down.

i would like to take this opportunity to mention that NEVER ONCE IN NURSING SCHOOL DID ANYONE MENTION THAT I WOULD BE ASSAULTED ON A ROUTINE BASIS.

please excuse me while I go put in my transfer to the OB floor.

be forewarned: this is a rant.

"those who can, do. those who can't...apparently run this place"

i have a love hate relationship with our trauma team. mostly hate. as a whole, the team is made up of underachievers. the residents are less concerned about quality patient care and interventions that make sense, and more concerned about guessing which orders their seniors would like them to write. they don't order tests, because they don't want to know what's going on. they hate labs, because then they will be obligated to come up with interventions. they loathe medicine doctors above all else, and frown on nurses who call on them for help in emergencies. i have decided this is because they feel threatened by these doctors because they know about medicine. they have taken nearly everything that i learned in nursing school and thrown it out the window. there are many days that i feel personally victimized by our trauma team, one of those being today.

i have a patient that i'm watching like a hawk. he's here because he stabbed himself. when i got him out of surgery, his heart rate was in the 140s-150s. not ok. the team ran a few tests, and determined that he wasn't having a cardiac issue and that his blood counts were decent. apparently this was good enough for them, so we let the patient sit at this heart rate for 24 hours.

the next day, he became short of breath. they sent him for a chest CT and found out that he had a pulmonary embolism. NOT OK. i have watched people die horrible deaths of PEs in front of my face, and as a result i live in fear of them. it's the kind of condition where a person is talking to you one minute and the next they aren't breathing...completely terrifying and emotionally scarring. so one can imaging how i felt when i found out that the patient had not one but two PEs in the left lung...kind of like i had just been handed a ticking time bomb. i started the patient on a heparin drip to thin his blood, and we kept a close eye on his vital signs.

so imagine my surprise when i come to work today and my patient is off his heparin drip. when i asked the day nurse why, she quoted the trauma team. "his PEs are little...he probably had them before he came in. and he doesn't have insurance". allow me to break down the things that are wrong with this into an itemized list.

1. the PEs are little. ok, so certain types of PEs aren't as serious. but personally, even the thought of little ones make me want to wet my pants.
2. he probably had them before he came in. maybe. although this would fall under another of the trauma team's biggest faults, the failure to acknowledge/treat/give a crap about pre-existing conditions. basically, the doctors will say "this is their baseline" and use that as an excuse not to deal with the problem. once again, not ok. and for the record, the patient's first EKG didn't show changes that would happen due to PE, and the second and third EKGs did. therefore, we might want to rethink this theory, people.
3. he doesn't have insurance. i think i can sum that one up with a OH NO YOU DIDN'T.

fine, so we aren't going to treat his PEs. but he also has chest pain. and blood counts that are half of normal. and suddenly, i understood!!! his body doesn't have enough blood cells to deliver oxygen to the heart. low oxygen equals chest pain. this can also explain his sickly grey death skin and the fact that he just sleeps all day long. it was like heaven opened up and the angels sang. we could give him blood and he would be better!!

so i did what a good nurse is supposed to. i went to the resident and presented my evidence. i had labs to back me up. i had a good argument based on pathophysiological principles. i followed the right steps. and then i got the order, gave him blood, and everything was perfect, the end.

oh wait. actually i was told that "it will be discussed", and then my (right) idea was completely shot down and the team decided to give him some lasix to get rid of extra fluid. apparently the idea de jour is that his blood counts are low because his blood is diluted. DID WE ALL GET OUR MEDICAL LICENSES OUT OF A CRACKERJACK BOX?!?!?!

i am tired of being rejected by the trauma team. i'm tired of working hard to think critically to have no one take me seriously. i'm tired of the groupthink. and i'm tired of caring about these patients and feeling like nobody else does.

but do you know what i'm not tired of? being right. mark my words i WILL give this man blood if it's the last thing i do. because he needs it. it will make him feel better. and it is medically appropriate. and i don't need the trauma team to validate my feelings.

but i will enjoy saying i told you so.

rant over.

a day in the life

today was quintessential trauma drama. for the entire shift, i found myself scowling and holding back tears. now that i am home and halfway through a glass of wine, however, i can see the hilarity in many of the situations that made me think that i was (finally) going to lose my mind. here's the rundown.

1400: pick up patient named after pop icon. said patient insists on doing dances with his IV pole, repeatedly running into walls and nearly falling over. patient gets 8 beers a day. insists on calling my nursing student "the apprentice". immediately love said patient.

1700: patient's wife complains that bathroom is "filthy". bite back comments about not being able to control explosive diarrhea. scrub poopy bathroom with bleach wipes. try to smile like i mean it. rue the day i became a nurse.

1845: receive patient from ED. no report given. patient is 305 pounds and 5'6''. cannot get patient off cart. call more staff, almost drop patient on floor. call ED and ask if report was recorded. talk to developmentally delayed ED nurse who allegedly recorded report and yet can tell me nothing about patient. hold back angry rant against ED nurse and hang up.

2045: go into favorite pop icon patient's room and notice epidural is leaking. must have been from the dancing. call doctor, stop pump. answer 234235 million call lights. call different doctor for new pain meds. call doctor again for benadryl for another patient. stalk doctor in halls and get cough syrup for a third patient. take phone call from yet another doctor and am warned of the dangers of epidural hematoma with displaced epidural line. talk to pop icon about dangers, then feed him more beer. call yet ANOTHER doctor about new admission, as patient was admitted with weakness and all admitting orders say constipation. cry.

2100: go into chart of new admission and read note from ED RN. RN has written that i called for report and that it was clearly recorded in the system. complain to nurse manager. receive apology from ED. plot revenge.

2115: respond to screaming match from patient's room. listen to patient's gf yell "YOU WAS TRYIN TO KILL THE MOTHER OF YO BABY". watch security remove gf from room. observe as patient attempts to go after gf and then hits security with crutches as they try to hold him back. police arrive, listen to patient swear the whole thing never happened. go into room of patient next door and assure her she is not in danger.

2130: remember i am supposed to be holding a meeting for night shift nurses. have no time for meeting. feed nurses instead and continue to run around floor.

2200: pass meds. console crying patient that i have neglected for hours. drop meds on floor, and have to order new ones. hold down elderly woman for straight cath. try not to get bitten. listen to patient threaten nurse for taking away his crutches.

2300: finally begin to chart.

2330: listen to report from ED patient. incorrectly recorded. feel vindicated.

2345: punch out. contemplate self harm. consider winding up as patient on floor and reconsider. decide to drink wine and sob myself to sleep instead.


so here we are.

today i get to eat my words. yum.

sadly, i am not as nice as i used to be. somehow after almost 3 years of trauma drama, i've gotten cynical. nursing is a frustrating job. you watch the same types of people make the same types of bad choices and you aren't supposed to be angry. you have to deal with patients manipulating you and dish out drugs like candy and you're just supposed to smile as you get walked all over. it's hard, and it makes me mad, and as a result i can be judgmental and snotty.

but really. excuses get me nowhere. today i was wrong and here is why:

i was sitting up at the nurse's station with a couple of coworkers working on charting. the tele monitor was alarming, as it had been all night. we have a patient on the floor who is constantly pacing the halls. she's always out to smoke, or otherwise disposed and her tele is either too far away to give off a signal or her leads are bouncing around and the monitor thinks she's in v-tach. at this point, the monitor was saying that her heart rate was in the 140s. one of the nurses asked why, to which i replied "she's probably out smoking or doing whatever she does". well (surprise surprise) the patient is actually NOT out smoking, but right outside the nurse's station, overhears everything i say, and proceeds to tell me so and then yell at me. enter me. dying inside. because, unfortunately, she's right.

yes, i said it.

this patient is a drug addict. she manipulates the system. she has a history of doing naughty things in bus shelters. but that doesn't mean that i am judge and jury of the trauma unit. that doesn't mean that she gets treated with any less respect, or that i get to say whatever i want about her. because, really, she is none of my business. i (thankfully) am not her nurse and her antics are not my responsibility, so i don't get to have an opinion.

this is hard for me. i see injustice and i want to stamp it out. i would like things to be fair and right, and people like this DRIVE ME OUT OF MY MIND. i don't get to go around and do anything i want without consequences. i don't demand things and have people fall all over themselves to grant my requests. i don't manipulate the system. but once again, it doesn't matter. because i am not the drug addict, i am the professional. and because of that, and also because i was wrong, i got to go and apologize.

can i just say that i thought i was going to get beat down? she actually said to me "if we were out on the street it wouldn't have gone like that". but despite the threats of bodily harm, i apologized. i told her that i was wrong and that my comments were uncalled for. that it was inappropriate and none of my business. and that i was sorry. and she accepted my apology. and then ranted about me to anyone who would listen for the next 2 hours.

frankly i am horrified by the whole incident. do you know what is not fun? taking care of shallow selfish people. do you know what is even more not fun? stooping to their level. so tonight i ate my own words and i deserved every bite. and tomorrow? i may need a disguise.

patient advocacy, yet another joy of nursing.

i am trying to think of a way to say this diplomatically. nope, can't do it. SURGEONS TOTALLY SUCK. ok, so today it was just one in particular. let me explain.

i have a 91 year old post-op patient. this in itself is actually very bad. 91 year olds shouldn't have surgery. please, if i am ever that old and someone wants to cut me open, slap a DNR bracelet on me, cover me with a palliative care quilt and call the harpist to play me into the light. i want this on the record!! unfortunately, this lady wasn't so lucky. she had surgery, then had complications, then her extremities filled with fluid, her lungs went to crap, and she got a couple of infections. Now she has so much fluid in her legs that my handprint stays on her when i touch her. and her lungs are so wet that you can hear her rattling from the doorway. and as all this fluid is in inappropriate places, she is actually dehydrated and has had only a small amount of urine output in 24 hours.

enter me. i came to work today feeling the need to right wrongs. i had the patient the night before, and was concerned about her fluid status and urine output. the on-call doctor that night didn't want to do much because he didn't know the patient. so when i got to work today, i was anxious to find out what was being done.

enter the surgeons. what was being done? ABSOLUTELY NOTHING. now on some level i understand this. we can't give her fluid because it's not going to the right places. we can't pump her full of diuretics because her kidneys can't handle it. we can't cure her because she is 91 and she's probably going to die. but we CAN do something, namely making her a palliative care patient and getting her comfortable.

enter me talking to the surgeons. i really did try. i sat down with the chief resident of the surgical service, the nurse practitioner, the intern, and the med student. i explained my concerns. i went through her edema, her lungs, her urine output, etc. and when i was done, i waited for the chief resident to respond. and what did he say?

"no."

that's right, no. just no. ok, excuse me? what part of what i just said did you not understand? so i repeated myself. the conversation went a little something like this.

-i explained that if the patient is not palliative care, we have an obligation to treat her.

"well what do you want me to do about it"

-i explained that i thought we should make her palliative

"no"

-well then we should really have a meeting to discuss what we're doing with this patient, because there's some confusion and not everyone is on the same page

"what do you mean there's confusion. who exactly doesn't understand."

-NURSING! I DON'T UNDERSTAND WHAT WE'RE DOING. AND YOU OBVIOUSLY DON'T UNDERSTAND WHAT I'M SAYING.

"well what can we do to make YOU happy then"

-i explained that we needed to make a decision about the plan of care

"well i don't understand why you're so concerned about putting a label on it"

-i explained that these 'labels' exist so that we're not passively killing people. and if i don't have such labels, i will treat my patient accordingly. thus when she starts circling the drain, i will call my resources and we will do labs and tests and oh i don't know TREAT HER, because i have no reason not to. i believe this is also when i started throwing around phrases like 'failure to rescue' and 'obligation to my patient'. i finished up by saying that i didn't feel comfortable with this grey area of medicine, and with watching her slowly drown to death. if the surgeons want to kill their patients in the OR, that's on them. but when they try to do it on the floor, thats on me. (ok i said that last part a little more politically correctly, but the gist is the same). then i told them that i would let them discuss things and they could get back to me with their decision.

now this should have felt awesome. and actually, it was very satisfying. i said what i needed to, and i stood up for myself and my patient. i didn't get intimidated, and i didn't back down even when it was clear that i wasn't going to get what i wanted. but i don't particularly enjoy eye rolling and snippy comments and tall bald men in white coats talking down to me. so was i mad all shift? yes. and do i harbor revenge fantasies involving me running over said chief resident with my SUV? yes. and will i add him to my list of people that are not to touch me should i ever need surgery? yes. and i will underline his name.

for the record, i didn't get what i asked for. the patient is still hanging out, not being treated but not officially palliative care. but for my trouble, i got 20 mg of lasix by mouth! i like to think of that as my consolation prize. i'm sure that i also got a reputation as a crazy vigilante nurse. but at this point, who cares? i can go to sleep tonight knowing that i advocated for my patient. and that evil chief resident? he'd better watch out in the parking lot.

rules of trauma

rule: bad things happen to good people. bad things also happen to bad people. however, bad people are invincible, while good people have horrible luck.

case in point: this week i had a normal trauma patient. this in itself is news-worthy. this poor woman is a doctor who was heading home from work. it's 2 in the morning and some drunk idiot is out on the roads in his 3/4 ton pickup and hits her head on. surprisingly, her injuries were relatively minor. or so we thought until we got a scan that showed that she has bilateral carotid dissections. this is very bad, basically a stroke waiting to happen. so we put her on anticoagulants and got a repeat scan after 5 days. i honestly thought that she was going to go home the next day. she was a model patient, up walking and talking, looked great. but the scans were worse. and now she probably needs a stent, which has a good chance of knocking a clot off of her carotid artery and making her have a stroke. or we could leave the artery as is and it could completely occlude and she could have a stroke. see the dilemma?

this is why i am upset:

1. she is a nice normal person just doing her job and she has this horrible accident happen to her. why? because other people are stupid and reckless. you can bet that pickup man is just fine. why? because he is a bad person. and bad people are invincible.

2. she has young kids and they should have a fully functioning mom who is not a ticking time bomb.

3. she might not be able to do her job anymore. she's a doctor. doctors aren't doctors because they want to be, they are doctors because they have to be.

4. i am getting very tired of watching bad things happen to good people. it's just not fair.

counter case in point: another patient, this one not mine. double D from the block. he had the misfortune of getting shot through his liver and still somehow living to drive us all crazy despite having no blood pressure in the field. but have no fear!! gangsters are invincible. double D can continue to manage his drug cartel or do whatever it is that he does from the comfort of the hospital. every night like clockwork, we have what i like to call "D on parade". around 8 pm, all of D's friends and family would show up. the group included 3 baby mamas, various infants and toddlers, aunts, cousins, homeboys...for a grand total of at least a dozen people. despite the fact that D has 2 perfectly good legs, he would sit in his wheelchair and insist on being pushed up and down the hallway for a good hour, obstructing traffic and generally being a pain. as the group walked (at a snail's pace) up our very narrow halls, they would stop at various rooms along the way and pick up other members of the community. note: when you are in the hospital and coincidentally know 2 other people on the same floor who also happened to get shot at the same time as you IT IS TIME TO MOVE. and on it went, sloooooow up the front hall, slooooooow up the back hall. back down to the room. repeat. then someone had the bright idea of wedging a couple of kids in a second wheelchair just to make sure that the entourage really took up all available hall space. this literally happened EVERY NIGHT.

now i realize that this sounds judgmental, and i'm certainly not saying that anyone deserves to be shot. but when you still have a house arrest bracelet on your ankle and i watch your 3 different baby mamas rotate shifts, i am inclined to believe that you are living in a gangsta paradise, and may just have played a small part in your fate. and when you refuse to do any of your own cares, snap and clap at the nurses to communicate your needs, and pee/poop the bed out of laziness and entitlement then insist that we clean you up despite the fact that you are perfectly capable of doing these things independently, i am inclined to resent you.

so to recap: we have a productive member of society. kind, polite, participates in own cares and follows medical instruction. then we have a felon. rude. obstinate. unwilling to do even the most basic things despite the fact that he is perfectly capable.

lets take a guess. who walked out (or was wheeled out by an entourage member, most likely) unscathed, and who is facing a very serious diagnosis with a crappy prognosis?

that's right.

you have GOT to be kidding me.

Yesterday I got a very special patient out of the ICU. I don't mean special as in needs, or a crazy diagnosis. This guy is the stuff that stories are made of. I'm pretty sure that I will never [be able to] forget him, and here's why.

I was getting an ICU transfer and frankly I thought I was pretty lucky. He just had his gallbladder removed, was pretty stable, and just got admitted to the ICU overnight to monitor a preexisting heart condition. This guy is in his late 20s, walking, talking, and sounded like an easy patient. INCORRECT.

The guy rolls in and the first thing he does is strip completely naked in his bed because "I like to sleep naked". Sidenote: this is fine AT HOME IN YOUR OWN BED. Please do not make me see these things. Yes, I am a nurse, but that doesn't mean that I want to see 300+ pounds of what your mama gave you hanging out for 10 hours in a row. Ok. So the naked man now begins to give me orders because "I'm kind of OCD". Whatever. I spent the next half hour feng shui-ing his room and fetching a fan to aim at the wall because "I need circulating air", water, blankets, suction for when "I need to cough and there's this hunk of phlegm way back there and I need to suck it out", pillows, special pillowcases to wrap his legs in because the SCDs make his legs sweat...and so on. At this point I still thought maybe the evening could be redeemed. Maybe once I got him settled he would just leave me alone.

HA.

It is now 1600. At 1615 I go eat my lunch. If I don't go eat my lunch at 1615, I do not have time to eat and that makes me very sad. Needy needy man, of course, chooses now to request his bed bath. First of all, he already got a bath, and I know it. So I hinted around that he already got washed up in the morning, to which he replied "at home I take like 4 showers a day. I like to be clean". Can we say overkill? I could maaaaaaybe understand 2 showers a day, but 4? That's not cleanliness, that's mental illness. Fortunately for me, at 1600 we had no linens on the floor, and I got to postpone bath time until after lunch. So at 1700 I headed in with my big stack of towels and got to work.

Forgive me if I'm wrong. Normal people do not feel comfortable being completely naked and taking a bath in front of their parents and brother. Well, this patient thinks that's A-ok. He spent a good ten minutes lovingly scrubbing his special place while his entire family sat in the room. For the record: NOT OK. This led to a lively discussion about mom, who had back surgery and wasn't allowed to bathe at all for awhile. "Not even your cooter?" asks special patient. No, not even there. This conversation? Also NOT OK.

So I make the guy wash everything he can reach and I helped him with his legs and back. Then, to my horror, he whips out a tube of hydrocortisone cream and proceeds to tell me about his rash. Apparently the hospital soaps don't work well with his delicate skin. He then begins lovingly rubbing cream on his special place. Yes, his family got to see this delight as well. Oh but the fun doesn't stop there. He goes into excruciating detail about the rash on his butt, and asks me to "just lube up a finger and run it all up the crack really good".

Sidenote: this is my life. If I had a dollar for every time a freaky patient with no boundaries asked me to do something repulsive, I could leave this job like 10 times over.

So bath time is done, thank God. But not to worry! The fun is far from over. Unfortunately, this guy had a catheter in that had started to leak. The day nurse took it out, and every hour for the next 6 hours I got to go in and empty a tiny bit of urine from the urinal. This led to a lengthy discussion about diuretics and my patient's peeing habits. For the record, I do not enjoy hearing about your pee unless I ask you. Otherwise you can just keep that to yourself. Thanks. We also had another issue as my patient informed me that he "dribbles". This means that every time I emptied his urinal, I also had to bring him more linens for his "accidents". I'm sorry. 29 years old and haven't quite mastered the art of peeing yet? This may be a life skill that you should be working on.

And this all went on until 2300. Like clockwork, the call light would go off every 20 minutes and I would go down to his room and be presented with a list of four to five items that I would haul back to his room. Once I got down there, he would remember several other "favors" to ask me. It got to the point where I was praying to be fired or just drop dead...ANYTHING to not have to deal with this patient another second.

To clarify, I don't have a problem helping people, that's my job. I do however have a problem with excessive neediness. Group your requests together so I'm not doing laps up and down the halls. If you can do something for yourself, then JUST DO IT. Don't make me do it, don't make me watch you, I am NOT going home with you so if you can't wipe your own butt we need to figure that out before you go. And for the love of all that is good, HAVE SOME MODESTY. It will not kill you to wear a gown, so leave yours on, please.

So today I go back for more. Maybe he'll get discharged? Oh please oh please oh please.

have i mentioned lately that i love my job?

septic medicine patient from africa? she might have tuberculosis. and considering the fact that i spent about 20 hours with her without a mask, if she has it i've been exposed.

when i go to the doctor there's a question that asks if you've been exposed to any hazardous materials. i usually say yes and write "patients" by way of explanation. this is why.

so now we wait for the results of the bronchoscopy.