"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.
Friday, March 25, 2011
Friday, March 11, 2011
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.
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.
Thursday, March 10, 2011
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.
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.
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