so we get this lady from the ED. she's a bad COPDer with a crap ton of heath problems who was found down at home barely breathing and for some reason rushed to the ED. they can do basically nothing for her because she is a DNR/DNI. well, nothing except for bipap. and by golly!! it worked!!
unfortunately.
this woman was so crazy, that i wanted to hurt myself. that's right, not hurt her, but myself. self-destruct mode. three gallons of crazy in a two gallon bucket. cray.
it all started with her "running leg syndrome". ok, first of all ma'am, if you're planning on faking a disease, take the time to get the name right. now i'm not going to say that i don't believe in RLS. maybe i do, maybe i don't. but i know for a fact that restless leg does not make you buck around in bed to the point where i have to put seizure padding on your siderails. restless LEG. legs. not arms flailing and head twitching and an occasional seizure-like spasm for good measure.
also, your RLS becomes less credible when you tell me that ativan and oxycodone are the only things that can help you. the drug seeking seems obvious, yet i find these things on your home med list in obscene doses.
ooooooooohhhh, so your dealer...excuse me, your doctor, prescribes them for you. how thoughtful.
so she got half her home dose of meds for the RLS show: 1mg of ativan and 15(yes, she takes 30 at home) of oxycodone.
and oh, the sweet silence that ensued. until she became unresponsive. rock solid vitals, eyes open and looking around, but no one was home upstairs.
narcaning her was a crime against myself.
to make a long story short(er), she required 4 vials of narcan, 3 sets of STAT ABGs, and someone to hold her down so she didn't rip off her Bipap. and this is on half of the home dose.
so in the morning, when she sobered up, the true story came out. the patient couldn't sleep because of her restless legs, so she decided to take triple the amount of medication she was prescribed, a whopping 6 mg of ativan and 90 of oxycodone.
ninety milligrams of oxycodone. NINETY MILLIGRAMS OF OXYCODONE, to a woman who is approximately 115 pounds and can't breathe at baseline.
it makes me want to bang my head against the wall and not stop. self. destruct.
yes, people are that stupid. and yet somehow this stupidity is rewarded, and she gets to continue breathing even though she very well should have died because she was so stupid.
once again, if you have no regard for your own life, please do not come to the hospital and make your problems my problems. if you want to take enough drugs to kill yourself over a disease that is ALL IN YOUR HEAD, stay home and die.
yes, that's a horrible thought. it's cold and uncaring and mean and i should be ashamed of myself. but isn't it the truth?
is it so much to ask that fully functioning adults take some responsibility for their health? that they don't do blatantly stupid things like triple dose themselves on narcs and benzos?
i don't think so . do you?
Monday, December 31, 2012
Thursday, December 27, 2012
the jury is still out
...on whether or not my nursing spidey senses have once again prevailed.
the patient: middle aged, just "fell" on a drill bit square in his neck. odd for sure, but now odd and hypertensive and tachycardic and tremoring up a storm.
my thoughts? when you likey 4-6 tall boys every day (and i'm sure that this is a conservative estimate), you DT fast and you DT hard.
the chief resident? gave me my 2 mg IV ativan q 6, but says "he looks fine".
don't borrow trouble? maybe. but in my opinion, this will be an issue. a sweaty, seizure-y, run him up to the ICU issue if we're not pretty proactive.
so i'll keep you posted.
***
so i can't be sure, but i think that the fact that the ativan was up to q2 by this morning means that maybe the nurses were on to something...but, no worries!! we will never know for sure as the team has made sure to ship the patient over to psych before he can hardcore DT so they don't have to deal with it. another crisis of patient care narrowly averted.
***
the patient: middle aged, just "fell" on a drill bit square in his neck. odd for sure, but now odd and hypertensive and tachycardic and tremoring up a storm.
my thoughts? when you likey 4-6 tall boys every day (and i'm sure that this is a conservative estimate), you DT fast and you DT hard.
the chief resident? gave me my 2 mg IV ativan q 6, but says "he looks fine".
don't borrow trouble? maybe. but in my opinion, this will be an issue. a sweaty, seizure-y, run him up to the ICU issue if we're not pretty proactive.
so i'll keep you posted.
***
so i can't be sure, but i think that the fact that the ativan was up to q2 by this morning means that maybe the nurses were on to something...but, no worries!! we will never know for sure as the team has made sure to ship the patient over to psych before he can hardcore DT so they don't have to deal with it. another crisis of patient care narrowly averted.
***
Tuesday, December 18, 2012
the other side.
1/8/12
my grandma was in the hospital all week. it started with some bleeding, and a CT scan revealed some lesions on the liver and kidney. the liver was biopsied, so now we wait.
i love control. at work, in my real life, i like to be in charge. i like my routine, and i don't like change. i like being able to micromanage. with my patients, i like to be able to see all of their labs, read all of their notes, and quietly obsess over vitals and I+Os. i know when the creatinine is trending up that we need to DC the toradol, and i know when the K is borderline to get rid of it in the IV fluids. i can usually tell who we're going to need to transfuse, and I know who's going to be a problem child because their WBCs are so high.
but i don't know how to be a family member of a patient. i don't know how to wait for information that i'm used to looking up or paging someone until i get an answer. i don't know where i'm supposed to put this anxiety. and none of the platitudes that i offer to my patients and their families like "one day at a time" are working for me.
and if we don't know the results of the biopsy, then why does grandma need to meet with an oncologist on wednesday?
all that i've pictured for the last 4 days are the faces of the people that i've taken care of who have been dying of cancer. the patients that i've sent to hospice with only a few weeks left. and the black and white newspaper obituaries that sometimes get pinned to the bulletin board.
i am on the other side now. and i am terrified.
12/12/12.
my grandma died 5 days ago. i guess if i had to, i would say that it was a lot like i pictured it. at the end she didn't look like herself at all. my family told me she was "sleeping a lot", but really she was unresponsive for about 4 days before she died. and the other side? it's hard, for sure. the hospice part of it was hard. sitting for hours around the bed of someone who doesn't even know you're there. having to deal with the onslaught of well-meaning people who say nice things that only make you feel worse. 'there isn't anyone like your grandma anymore'. thanks for reminding me. and the nursing staff at the home where she died? don't even get me started. the LPN was so clearly terrified of the dying process that she practically ran in the room, shoved the syringe of liquid morphine down grandma's face, and ran out without so much as a "is there anything i can do for you?". some people apparently are too busy for compassion.
but i digress.
it's hard for me to believe that 11 months after i wrote this, grandma is gone. it seems like a long time, but also not nearly long enough. and i knew exactly what was coming, but it was all still, somehow, such a surprise.
cancer is a horrible thing. her's was "urothelial"...bladder but not bladder, kidney but not kidney. by the time they found it, it had mets to the liver and to the pelvis. i still am shocked at how it got so big with no symptoms at all.
or, if we're being honest, i look back on a UTI that i told my grandma to get checked out the easter before she was diagnosed and see that as "the sign". in 20/20 hindsight, i blame myself for not knowing, which is stupid, i know. but i digress again.
she did so well for awhile. not sick. didn't lose her hair. moved slower than usual, and couldn't do as many things, but still ok.
and we had such a nice summer...it was a cancer stay-cation. no chemo, no radiation, just a 3 month long pause to pretend like nothing was going on. and pretend i tried.
but then after that, the scans were worse. the liver met was 4 inches round. there were new lesions in the spine and the lungs.
and, one day, she couldn't walk to the bathroom.
that led us to 14 days in the hospital, which was pretty much hell. MY hospital, to be exact. who's surprised that i had a hard time giving up control of her care? no one? ok. to my credit, i did only helpful family member things and knew my place. i made suggestions when asked, but did not completely take over. and as hard and stressful as that time was, i felt like i knew what was going on. the nurses saw me come in, they knew who i was. they would talk with me honestly, and take my concerns seriously. the doctors were nothing but receptive and kind, and made sure that grandma got what she needed. so maybe it wasn't hell after all.
the nursing home on the other hand...now that could probably be considered hell. the nursing home is a book all it's own. as someone who had relatives in the home for years starting when i was young, i take issue with the environment as a whole.
first of all, why on earth is there a big bird cage in every home? birds are creepy, their eyes are blank, and when you park a bunch of drooling slumped over seniors in front of them...it's what horror movies are made of. also: nursing home smell? gross. shared rooms (especially when someone is dying), so awkward. and the barking cough of the guy across the hall? PERTUSSIS. i google-audioed it. seriously people, what's wrong with you.
and oh, the staff. lord have mercy the staff. my personal favorite would have to be the 'charge nurse' who told my mother that she really had to let them give grandma something for pain because "i just can't handle her screaming like that".
ok, lets back it up here for a second.
1. we did not say you couldn't give her anything for pain. we just didn't want you to give her the ridiculous amount of pain meds that made her hallucinate that she was dead and call my family at 3 am to tell them to call the funeral home because she was in heaven.
2. do you have something against senna? because i'm pretty sure that our pain issues have something to do with the fact that you have given her so many pain meds that she can't poop ever again.
3. this nurse also told my family that we wouldn't have to turn grandma anymore, because it was "too painful, and now you have that special air mattress so we don't have to worry about it". she's lucky i wasn't there for that one, or else i would have strongly considered punching her face.
4. also, i could care less what you CAN'T HANDLE. this is not about you, for the record.
(rant over)
so the end. the end was not as bad as i thought, and also kind of worse than i thought. i have seen people die before, this is true. it's different when it's someone you love. and if i had to describe the experience, i'd call it surreal. it feels like it happened to someone else.
i was there. i held her hand as she took her last breath. my mom was there too, and my aunt, but i was the only one who knew what was going on. i was the only one who could tell it was so close. when you're on the other side, you know too much. and also you forget that other people don't know as much. it's lonely.
i thought that "the moment" would be bigger than it was. it wasn't. to me, she was already gone. she was gone the minute she wasn't who she always was: my sassy, opinionated, fearless, strong grandma.
and now she's gone.
it's very strange. in a lot of ways, i feel the same. i have been grieving this loss for 11 months. i have been scared that her death would be so horrible that it would overshadow her life. that i wouldn't be able to remember the good times because my mind would be so full of the painful images of her last days. that she would become some sort of cancer-ridden "shell" person that would rob me of the woman i knew and loved.
but that didn't happen.
and i'm not scared anymore. just sad. really really sad.
i don't know how much of this is ok to say. i drafted the original post because it was "too personal", and i don't really do that. but this is the only way i know to get the feelings out. the only way i know to process this loss.
12/17/12
we buried my grandma today. she's no longer in pain. i'm no longer afraid. is it wrong to be so relieved? for the past year, i've been a little cynical, i must admit. cancer was constantly on my mind, and anything awful that happened in the world, whether it had anything to do with me or not, came as a personal attack. it felt like the world was dark, and just getting darker.
it makes no sense to me that now, ESPECIALLY now, with all the horrors of the past week, that suddenly i can see the good in the world.
but i am seeing it.
and after feeling so sick at heart for the past year, so scared of the unknown, already grieving for what was yet to come...for the first time in a LONG time, i feel some peace.
my grandma was in the hospital all week. it started with some bleeding, and a CT scan revealed some lesions on the liver and kidney. the liver was biopsied, so now we wait.
i love control. at work, in my real life, i like to be in charge. i like my routine, and i don't like change. i like being able to micromanage. with my patients, i like to be able to see all of their labs, read all of their notes, and quietly obsess over vitals and I+Os. i know when the creatinine is trending up that we need to DC the toradol, and i know when the K is borderline to get rid of it in the IV fluids. i can usually tell who we're going to need to transfuse, and I know who's going to be a problem child because their WBCs are so high.
but i don't know how to be a family member of a patient. i don't know how to wait for information that i'm used to looking up or paging someone until i get an answer. i don't know where i'm supposed to put this anxiety. and none of the platitudes that i offer to my patients and their families like "one day at a time" are working for me.
and if we don't know the results of the biopsy, then why does grandma need to meet with an oncologist on wednesday?
all that i've pictured for the last 4 days are the faces of the people that i've taken care of who have been dying of cancer. the patients that i've sent to hospice with only a few weeks left. and the black and white newspaper obituaries that sometimes get pinned to the bulletin board.
i am on the other side now. and i am terrified.
12/12/12.
my grandma died 5 days ago. i guess if i had to, i would say that it was a lot like i pictured it. at the end she didn't look like herself at all. my family told me she was "sleeping a lot", but really she was unresponsive for about 4 days before she died. and the other side? it's hard, for sure. the hospice part of it was hard. sitting for hours around the bed of someone who doesn't even know you're there. having to deal with the onslaught of well-meaning people who say nice things that only make you feel worse. 'there isn't anyone like your grandma anymore'. thanks for reminding me. and the nursing staff at the home where she died? don't even get me started. the LPN was so clearly terrified of the dying process that she practically ran in the room, shoved the syringe of liquid morphine down grandma's face, and ran out without so much as a "is there anything i can do for you?". some people apparently are too busy for compassion.
but i digress.
it's hard for me to believe that 11 months after i wrote this, grandma is gone. it seems like a long time, but also not nearly long enough. and i knew exactly what was coming, but it was all still, somehow, such a surprise.
cancer is a horrible thing. her's was "urothelial"...bladder but not bladder, kidney but not kidney. by the time they found it, it had mets to the liver and to the pelvis. i still am shocked at how it got so big with no symptoms at all.
or, if we're being honest, i look back on a UTI that i told my grandma to get checked out the easter before she was diagnosed and see that as "the sign". in 20/20 hindsight, i blame myself for not knowing, which is stupid, i know. but i digress again.
she did so well for awhile. not sick. didn't lose her hair. moved slower than usual, and couldn't do as many things, but still ok.
and we had such a nice summer...it was a cancer stay-cation. no chemo, no radiation, just a 3 month long pause to pretend like nothing was going on. and pretend i tried.
but then after that, the scans were worse. the liver met was 4 inches round. there were new lesions in the spine and the lungs.
and, one day, she couldn't walk to the bathroom.
that led us to 14 days in the hospital, which was pretty much hell. MY hospital, to be exact. who's surprised that i had a hard time giving up control of her care? no one? ok. to my credit, i did only helpful family member things and knew my place. i made suggestions when asked, but did not completely take over. and as hard and stressful as that time was, i felt like i knew what was going on. the nurses saw me come in, they knew who i was. they would talk with me honestly, and take my concerns seriously. the doctors were nothing but receptive and kind, and made sure that grandma got what she needed. so maybe it wasn't hell after all.
the nursing home on the other hand...now that could probably be considered hell. the nursing home is a book all it's own. as someone who had relatives in the home for years starting when i was young, i take issue with the environment as a whole.
first of all, why on earth is there a big bird cage in every home? birds are creepy, their eyes are blank, and when you park a bunch of drooling slumped over seniors in front of them...it's what horror movies are made of. also: nursing home smell? gross. shared rooms (especially when someone is dying), so awkward. and the barking cough of the guy across the hall? PERTUSSIS. i google-audioed it. seriously people, what's wrong with you.
and oh, the staff. lord have mercy the staff. my personal favorite would have to be the 'charge nurse' who told my mother that she really had to let them give grandma something for pain because "i just can't handle her screaming like that".
ok, lets back it up here for a second.
1. we did not say you couldn't give her anything for pain. we just didn't want you to give her the ridiculous amount of pain meds that made her hallucinate that she was dead and call my family at 3 am to tell them to call the funeral home because she was in heaven.
2. do you have something against senna? because i'm pretty sure that our pain issues have something to do with the fact that you have given her so many pain meds that she can't poop ever again.
3. this nurse also told my family that we wouldn't have to turn grandma anymore, because it was "too painful, and now you have that special air mattress so we don't have to worry about it". she's lucky i wasn't there for that one, or else i would have strongly considered punching her face.
4. also, i could care less what you CAN'T HANDLE. this is not about you, for the record.
(rant over)
so the end. the end was not as bad as i thought, and also kind of worse than i thought. i have seen people die before, this is true. it's different when it's someone you love. and if i had to describe the experience, i'd call it surreal. it feels like it happened to someone else.
i was there. i held her hand as she took her last breath. my mom was there too, and my aunt, but i was the only one who knew what was going on. i was the only one who could tell it was so close. when you're on the other side, you know too much. and also you forget that other people don't know as much. it's lonely.
i thought that "the moment" would be bigger than it was. it wasn't. to me, she was already gone. she was gone the minute she wasn't who she always was: my sassy, opinionated, fearless, strong grandma.
and now she's gone.
it's very strange. in a lot of ways, i feel the same. i have been grieving this loss for 11 months. i have been scared that her death would be so horrible that it would overshadow her life. that i wouldn't be able to remember the good times because my mind would be so full of the painful images of her last days. that she would become some sort of cancer-ridden "shell" person that would rob me of the woman i knew and loved.
but that didn't happen.
and i'm not scared anymore. just sad. really really sad.
i don't know how much of this is ok to say. i drafted the original post because it was "too personal", and i don't really do that. but this is the only way i know to get the feelings out. the only way i know to process this loss.
12/17/12
we buried my grandma today. she's no longer in pain. i'm no longer afraid. is it wrong to be so relieved? for the past year, i've been a little cynical, i must admit. cancer was constantly on my mind, and anything awful that happened in the world, whether it had anything to do with me or not, came as a personal attack. it felt like the world was dark, and just getting darker.
it makes no sense to me that now, ESPECIALLY now, with all the horrors of the past week, that suddenly i can see the good in the world.
but i am seeing it.
and after feeling so sick at heart for the past year, so scared of the unknown, already grieving for what was yet to come...for the first time in a LONG time, i feel some peace.
Friday, December 7, 2012
on overstepping.
nurses are just people like everybody else. so i guess it makes sense that not everyone is going to react to a situation the same way.
the patient was a man stabbed in the neck by his wife. he was immediately post op. he found out that his underaged child couldn't stay overnight, so he decided to leave AMA.
time to worry? for me, definitely. the guy just got out of surgery. the anesthesia is still hanging around, and lord knows it makes some people crazy. he shouldn't leave, or at least he shouldn't leave until the doctor could try to talk him out of it.
but his nurse saw it differently. she tried to talk him into staying and he wouldn't. she paged the doctor and he didn't call back. the patient was stable, he signed the AMA papers, she did all she could.
except call the chief resident. if one doctor isn't paying attention to you, you go above him. but when i suggested that she try that, she told me that she "wasn't really concerned about it".
well that made my blood boil. how could you not be concerned about a person who literally just got out of surgery with a stab wound to the neck up and leaving? she was WRONG.
so i paged the chief resident.
and the other nurse found out, and she was mad.
maybe it's because management is trying to push this idea of "all of our patients are all of our patients". they take that to mean that people can't walk past beeping IV pumps or bathroom call lights because "it's not my patient". but i take it a little differently. to me, it means that as a nurse on the floor, i have the responsibility to intervene in situations where i feel that a patient is not being provided with the care that they need. for example, if a patient looks sick and the primary nurse isn't doing anything about it, you jump in and start doing stuff, basically whether she likes it or not.
but it's a fine line to walk. and it's gone my way more than once. this lady was not my patient, but i pushed for her to be in the ICU because she was way too sick for the floor and her nurse was too new to realize it. this little old man wasn't my patient either, but he went to the ICU after i stumbled upon his nurse telling him to take deep breaths with sats in the 70s. and i've "helped" my coworkers this way more than even that.
because it's all about the patients, right?
or is it all about me? me being right, me liking to save the day, me wanting to be in charge?
things have gone the other way too. once i paged a bunch of doctors about a patient that wasn't mine who looked HORRIBLE, like he was about to code. turns out he looks like that quite regularly and they weren't impressed. and then there was tonight. i paged the chief resident, they were in a trauma, and he couldn't come up.
the patient took his papers and left AMA.
i overstepped my boundaries, made my coworker mad, and the whole thing came back to bite me.
and i'm thinking about it, and i really don't like myself for being this way. and just because people don't always do things the way that i would doesn't mean that their way is wrong. and it doesn't give me the right to take over every time i feel the urge to be in charge.
maybe i was right, and maybe i wasn't. i hold myself to a high standard, but maybe it's time to take some of my own advice and just focus on myself. would i let a brand-new post-op leave AMA without a fight? no. but he wasn't mine, and the responsibility for him does not fall on me.
when everyone on the floor was brand new, all the patients were essentially mine. but around here, in the land of turnover, "veterans" are two years out of school. so now that these girls have been here over a year, i guess it's time to let go.
and i guess that instead of overstepping, i need to just step away.
the patient was a man stabbed in the neck by his wife. he was immediately post op. he found out that his underaged child couldn't stay overnight, so he decided to leave AMA.
time to worry? for me, definitely. the guy just got out of surgery. the anesthesia is still hanging around, and lord knows it makes some people crazy. he shouldn't leave, or at least he shouldn't leave until the doctor could try to talk him out of it.
but his nurse saw it differently. she tried to talk him into staying and he wouldn't. she paged the doctor and he didn't call back. the patient was stable, he signed the AMA papers, she did all she could.
except call the chief resident. if one doctor isn't paying attention to you, you go above him. but when i suggested that she try that, she told me that she "wasn't really concerned about it".
well that made my blood boil. how could you not be concerned about a person who literally just got out of surgery with a stab wound to the neck up and leaving? she was WRONG.
so i paged the chief resident.
and the other nurse found out, and she was mad.
maybe it's because management is trying to push this idea of "all of our patients are all of our patients". they take that to mean that people can't walk past beeping IV pumps or bathroom call lights because "it's not my patient". but i take it a little differently. to me, it means that as a nurse on the floor, i have the responsibility to intervene in situations where i feel that a patient is not being provided with the care that they need. for example, if a patient looks sick and the primary nurse isn't doing anything about it, you jump in and start doing stuff, basically whether she likes it or not.
but it's a fine line to walk. and it's gone my way more than once. this lady was not my patient, but i pushed for her to be in the ICU because she was way too sick for the floor and her nurse was too new to realize it. this little old man wasn't my patient either, but he went to the ICU after i stumbled upon his nurse telling him to take deep breaths with sats in the 70s. and i've "helped" my coworkers this way more than even that.
because it's all about the patients, right?
or is it all about me? me being right, me liking to save the day, me wanting to be in charge?
things have gone the other way too. once i paged a bunch of doctors about a patient that wasn't mine who looked HORRIBLE, like he was about to code. turns out he looks like that quite regularly and they weren't impressed. and then there was tonight. i paged the chief resident, they were in a trauma, and he couldn't come up.
the patient took his papers and left AMA.
i overstepped my boundaries, made my coworker mad, and the whole thing came back to bite me.
and i'm thinking about it, and i really don't like myself for being this way. and just because people don't always do things the way that i would doesn't mean that their way is wrong. and it doesn't give me the right to take over every time i feel the urge to be in charge.
maybe i was right, and maybe i wasn't. i hold myself to a high standard, but maybe it's time to take some of my own advice and just focus on myself. would i let a brand-new post-op leave AMA without a fight? no. but he wasn't mine, and the responsibility for him does not fall on me.
when everyone on the floor was brand new, all the patients were essentially mine. but around here, in the land of turnover, "veterans" are two years out of school. so now that these girls have been here over a year, i guess it's time to let go.
and i guess that instead of overstepping, i need to just step away.
and the best excuse of the week goes to...
...the patient who was found shot in a crack house telling us that he was "just there to play dominos".
um no, you weren't. ok.
um no, you weren't. ok.
Thursday, November 29, 2012
trauma tries to kill (ok, maim) people, chapter 982374
trauma: a team that combines stupidity with arrogance to the point where it actually frightens me. i am SO SICK of these people thinking that they have any business managing anything besides bellies and rib fractures. tonight's comedy of overconfidence? trauma thinking that they can play urology.
the backstory is as follows. the patient is young, shot, shackled to the bed because he did something real stupid, screwed his whole life up, and now is being charged with murder. he has a big (like baseball sized) hematoma in his bladder, and trauma thinks that it's NBD that he's peeing straight blood. well, that is it wasn't a big deal until yesterday, when they decided to have me jam a garden hose of a foley up him and do intermittent bladder irrigations.
do you know what that is? that is 20 frenches of hell. and the young men folk hate anyone messing around in their special place as it is. but too bad, in it went and i tried to irrigate.
tried.
i could flush in, but not pull back. and when i flushed the patient would shake and break out in cold sweats. then his bladder would spasm and bloody drainage would pour out from around the foley. then he would stand up and fluid would pour into the catheter, as well as all over his gown, sheets, and the floor.
EVERY. TWO. HOURS.
torture. it was torture. i told trauma that the first day and begged for urology. but no, we're going to go with this as a "first step". and i told the chief resident later in the day that it still wasn't working. no response. then i told the NP the next day in rounds. no response. then i told the intern after dinner. no response.
and then, i lost it. because the situation was RIDICULOUS, their management of the patient was not ok, and i was over playing nice.
so i called my ladies over on the uro/gyn unit and had a little pow-wow. then i bladder scanned the patient and found that he had over 600ccs in his bladder. at this point i could irrigate and nothing would even come out into the foley bag. so i called the intern on call and told him that we needed a urology consult, NOW. but he was in the trauma bay, and someone was dying, and he needed to talk to his chief...blah blah blah.
so i politely ended the conversation and paged the urologist myself.
and he came in from home with his man-bag chock full of catheters and irrigated 3 liters into the patient and finally managed to suck out 300ccs of clot and 500ccs of urine. and then he took out my garden hose foley and put in one that was 2 sizes bigger. he tried to put the patient on continuous bladder irrigation, but the clots were so bad that the tubing kept getting clogged. so he irrigated some more.
i stayed in that room with the urologist for over and hour. there was blood EVERYWHERE. we soaked towels, all the bedding, the floor...blood was in urinals full of irrigation fluid and graduated cylinders and 60cc syringes and all over the patient. the MD would push in a syringe of fluid and pull back nothing but solid clot. (while we're on the subject of bleeding out of ones bladder, do you think that trauma would order an H&H? nah...)
but, don't worry guys, trauma can handle this. pssh.
and tomorrow, urology will come back and decide what's next. most likely a clot removal under anesthesia.
so tonight, trauma, i curse your name. i curse your arrogance, and your neglect, and the fact that you would not listen to me, and we are NOT FRIENDS. no we are not. i am friends with urology, and that doctor is lucky that i did not kiss his face because i almost did, i really almost did.
and THAT, ladies and gentlemen, is sadly what it takes to get things done on the trauma service...namely, going around the trauma service.
***and for the record, the next day the patient got a clot evacuation with urology and came back to the floor with a civilized sized foley and perfect clear yellow urine. the day after that, he was discharged to jail. you're welcome, trauma. you're welcome. ***
***and for the record, the next day the patient got a clot evacuation with urology and came back to the floor with a civilized sized foley and perfect clear yellow urine. the day after that, he was discharged to jail. you're welcome, trauma. you're welcome. ***
Wednesday, November 28, 2012
hierarchical feeding...
...aka, when the surgery attending climbs down off his holy mountain and proceeds to eat you. alive. in front of his entire service.
i must have missed the day in nursing school that said putting an SCD on a patient who's anticoagulated is sick and irresponsible. sheesh, you would have thought i put the thing around the guy's neck...
and then there was the fact that his brace was rubbing his leg and it was all my fault because i had no idea where the stump sock was. um. well maybe it was in dialysis. seeing as how that was where the patient had been FOR THE PAST FIVE HOURS.
so excuse me if every pillow is not fluffed quite so, and if there are extra linens at the foot of the bed (gasp!) but i was more worried about the fact that the patient has been repeatedly attempting to drink from an imaginary cup.
oh and also he's oriented x1 and his eyes are doing that rolly "i'm 'bouts to code" thing and frankly we have bigger problems than feng shui-ing his room.
so after i listened to all that noise which was a total waste of my time, we got down to business. the plan of care. i'm thinking sepsis: altered mental status, downtrending pressures, known source of infection...easy. but he had been worked up pretty good and nothing came back. CXR was negative. blood cultures negative. head CT negative. UA was pointless because he's colonized with VRE.
which leaves us with the last 2 things. the lactic acid and the ABGs.
i knew what i was getting into before i opened my mouth, and i almost didn't say anything because i was tired of being patronized, but that's just the way that the patient advocacy cookie crumbles sometimes.
did you know that "lactic acid is a $200 pointless test that tells you absolutely nothing and should be removed from the lab". and that "oxygen saturations via pulse ox are 99.9% accurate and you don't need ABGs to tell you what you already know"? well that goes against everything i have ever been taught and more than one case that i've seen, but oh well.
so that was that.
and then 2 hours later the patient bottomed his pressures out to 70/40 and got all hypoxic and started doing this weird staring at the ceiling thing with his mouth open that looked a whole lot like dying. so i packed him up, took him to the ICU, and watched them do all those expensive "pointless" tests that i had requested.
well i tried.
*i later found out that this patient eventually had a MI and died in the ICU. nursing instinct people...not to be ignored.*
i must have missed the day in nursing school that said putting an SCD on a patient who's anticoagulated is sick and irresponsible. sheesh, you would have thought i put the thing around the guy's neck...
and then there was the fact that his brace was rubbing his leg and it was all my fault because i had no idea where the stump sock was. um. well maybe it was in dialysis. seeing as how that was where the patient had been FOR THE PAST FIVE HOURS.
so excuse me if every pillow is not fluffed quite so, and if there are extra linens at the foot of the bed (gasp!) but i was more worried about the fact that the patient has been repeatedly attempting to drink from an imaginary cup.
oh and also he's oriented x1 and his eyes are doing that rolly "i'm 'bouts to code" thing and frankly we have bigger problems than feng shui-ing his room.
so after i listened to all that noise which was a total waste of my time, we got down to business. the plan of care. i'm thinking sepsis: altered mental status, downtrending pressures, known source of infection...easy. but he had been worked up pretty good and nothing came back. CXR was negative. blood cultures negative. head CT negative. UA was pointless because he's colonized with VRE.
which leaves us with the last 2 things. the lactic acid and the ABGs.
i knew what i was getting into before i opened my mouth, and i almost didn't say anything because i was tired of being patronized, but that's just the way that the patient advocacy cookie crumbles sometimes.
did you know that "lactic acid is a $200 pointless test that tells you absolutely nothing and should be removed from the lab". and that "oxygen saturations via pulse ox are 99.9% accurate and you don't need ABGs to tell you what you already know"? well that goes against everything i have ever been taught and more than one case that i've seen, but oh well.
so that was that.
and then 2 hours later the patient bottomed his pressures out to 70/40 and got all hypoxic and started doing this weird staring at the ceiling thing with his mouth open that looked a whole lot like dying. so i packed him up, took him to the ICU, and watched them do all those expensive "pointless" tests that i had requested.
well i tried.
*i later found out that this patient eventually had a MI and died in the ICU. nursing instinct people...not to be ignored.*
Friday, November 16, 2012
medicine
well the floor is a complete show right now, like BAD. why? two words: medicine overflow. I'm talking weird aseptic meningitis/west nile, neutropenic cancer patients, every other room getting pumped full of blood products, grey people who don't look compatible with life, bad. people who belong in the ICU, but can't go because they are not quite 75% dead yet, which is the threshold for admission through the pearly gates, bad.
SERIOUSLY. it is easier to get into heaven than into the medical ICU. ACTUAL HEAVEN.
i mentioned that i'm a trauma nurse, right? so you can take your chronically ill medicine patients and SHOVE THEM.
things that don't interest me, a list:
SERIOUSLY. it is easier to get into heaven than into the medical ICU. ACTUAL HEAVEN.
i mentioned that i'm a trauma nurse, right? so you can take your chronically ill medicine patients and SHOVE THEM.
things that don't interest me, a list:
- your fibromyalgia/chronic back pain that means that you either a. call me every 10 minutes for meds or b. spend the entire shift passed out in your bed with a half-eaten sandwich hanging from your mouth.
- CHF. seriously. it is dead to me. core measures? dead. to. me.
- toileting elderly people with UTIs. over it.
- your 3020928345 meds for your 35 documented chronic conditions, and trying to figure out what your dialysis days are and where your access is and which of your limbs are missing and if you are blind or not and managing your 300s blood sugars. not for me.
- syncope cardiac workups that obviously aren't cardiac and are actually just a waste of my time.
- arguing with you about your cardiac/renal/diabetic diet. if it bothers you that much, go to the vending machine or have your family bring you chicken wings like everybody else does and leave me out of it.
- the "history of" isolations. they inconvenience me.
- trying to locate your particular medicine doctor out of the 23490 medicine teams
- pointless labs for obscure antigens and swabbing every orifice for parasites and pertussis and AIDS, and then
- wondering if i have parasites/pertussis/AIDS from being exposed to you and your inevitable disgusting hacking cough you will cough right in my face.
in other words, i am not interested in medicine patients AT ALL. which is why i became a surgical nurse. so, unless your 80 year old with altered mental status also happened to get shot, kindly return her to the nearest medicine unit and send me someone with a suture line. k thanks.
Thursday, November 15, 2012
needs.
do you know what gets really old? putting my needs last. all the time. apparently this is the career path that i've chosen: the road to selflessness. in a word? overrated.
is it really so much to ask that i get an uninterrupted half hour at some point during the shift so i can eat? that's all i want!! thirty minutes. instead, today i crammed my dinner down my face in approximately five minutes and returned to running around the floor.
and speaking of uninterrupted, always being available is ridiculously annoying. all day long i wear a phone clipped to my neck. convenient, you say! not so. this is a torture device invented by 'the man' to make sure that i am operating at max productivity. because it's not good enough that i do three things at once, i now can take multitasking to the next level by being available to field phone calls at all times.
it's enough to drive me to drink. which i am, by the way. i am trying to cover my anger with wine and it's clearly not working.
i come to work and feel like i'm set up for failure most days. who's brilliant idea was it to remove half the staff from the floor all at once to go to meetings? as if it's not bad enough that i have to keep my own four patients alive, now i have become responsible for "watching" three other patients who i know nothing about. i dread the beginning of the shift, because it's chaos, all the time. forget seeing any of my patients, i spend the first two hours of the shift toileting the masses.
here's what i want: to feel like i'm actually accomplishing anything instead of just spinning my wheels. to get to eat lunch. to get to go to the bathroom once in awhile. to spend time with my patients and not constantly be interrupted by phone calls. to have someone help me every now and then so i don't feel like i'm being eaten alive.
because i have needs, too.
is it really so much to ask that i get an uninterrupted half hour at some point during the shift so i can eat? that's all i want!! thirty minutes. instead, today i crammed my dinner down my face in approximately five minutes and returned to running around the floor.
and speaking of uninterrupted, always being available is ridiculously annoying. all day long i wear a phone clipped to my neck. convenient, you say! not so. this is a torture device invented by 'the man' to make sure that i am operating at max productivity. because it's not good enough that i do three things at once, i now can take multitasking to the next level by being available to field phone calls at all times.
it's enough to drive me to drink. which i am, by the way. i am trying to cover my anger with wine and it's clearly not working.
i come to work and feel like i'm set up for failure most days. who's brilliant idea was it to remove half the staff from the floor all at once to go to meetings? as if it's not bad enough that i have to keep my own four patients alive, now i have become responsible for "watching" three other patients who i know nothing about. i dread the beginning of the shift, because it's chaos, all the time. forget seeing any of my patients, i spend the first two hours of the shift toileting the masses.
here's what i want: to feel like i'm actually accomplishing anything instead of just spinning my wheels. to get to eat lunch. to get to go to the bathroom once in awhile. to spend time with my patients and not constantly be interrupted by phone calls. to have someone help me every now and then so i don't feel like i'm being eaten alive.
because i have needs, too.
Monday, November 5, 2012
best discharge teaching ever
chief complaint: narcotic overdose.
"stop taking percocet that is not prescribed to you"
well that about sums things up, now doesn't it.
"stop taking percocet that is not prescribed to you"
well that about sums things up, now doesn't it.
Wednesday, October 31, 2012
so no compassion for you, then?
i have a lot of empathy. and it works for me. sometimes i feel so ridiculously sorry for someone that the only way to make me feel better is to make them feel better. so i fluff fluff fluff the pillows, wash some hair, obsessively organize the room...whatever it may be to make the patient feel well taken care of and like they're getting "extras".
so that's what i've been doing for my new 'lifer' who will sadly be in the hospital for probably almost ever. according to trauma, the guy was practically dead upon arrival. he's a hot mess: trached, tubes all over, multiple broken bones, required more than one -ectomy, just SICK. his bowels will. not. move. will not. after so many surgeries, his belly is a tangle of adhesions, and somewhere one of them is obstructing his small bowel. we feed him in one tube, it comes out the other. and, while he is getting nutrition, every day he seems to get skinnier and skinnier.
so he sits in his bed, looking like some sort of large frail bird. he's trached, so he can't really talk. he can't eat. he's clearly bored out of his mind. and every time i walk in his room to see him holding a picture of a family member and just staring at it, it breaks my heart.
how sad, to be in the hospital for months and to have every day be the same as the one before.
to not get to do the things you love.
to not be able to do the things that once came so easily.
to feel so isolated, and so hopeless.
like i said, it breaks my heart.
or, i should say, broke.
because low and behold, who shows up today? the police. and wouldn't you know it, the story wasn't quite the same coming from them. turns out the patient was drag racing drunk with some of his other drug selling felon buddies and ended up crashing his car. the police recovered thousands of dollars and some stolen electronics. there was also some sort of bribery involving the patient's mother who's silence could be bought for something like $10,000.
you have GOT to be kidding me.
i guess this stuff shouldn't surprise me anymore. it also shouldn't matter. and in a way, it doesn't. i'll still treat the patient the way i always have. and i still feel bad for his situation, bad for the fact that it will take months for him to get back to even a halfway decent life...that is if he doesn't die of complications first.
but for some reason, it still really bothers me. i feel like i was lied to. i've been treating the patient like a victim.
the only thing this man is a victim of is his own lifestyle.
i have a rule, and it is however you treat me, that is how you will be treated. you can be a murderer or a thief or an abuser and we will not have a problem if you are polite and respectful. i'm not sure why this situation feels so different, but it does.
so what do you do? is compassion a resource? does it go to those most deserving of it? or is it kind of like triage...given to those who need it the most, despite of why they arrive on our doorstep? can the feelings be taken out of it altogether? is it possible to provide compassionate care to people you think kind of deserve what they got?
i think it can be done. but we shall see.
you have GOT to be kidding me.
i guess this stuff shouldn't surprise me anymore. it also shouldn't matter. and in a way, it doesn't. i'll still treat the patient the way i always have. and i still feel bad for his situation, bad for the fact that it will take months for him to get back to even a halfway decent life...that is if he doesn't die of complications first.
but for some reason, it still really bothers me. i feel like i was lied to. i've been treating the patient like a victim.
the only thing this man is a victim of is his own lifestyle.
i have a rule, and it is however you treat me, that is how you will be treated. you can be a murderer or a thief or an abuser and we will not have a problem if you are polite and respectful. i'm not sure why this situation feels so different, but it does.
so what do you do? is compassion a resource? does it go to those most deserving of it? or is it kind of like triage...given to those who need it the most, despite of why they arrive on our doorstep? can the feelings be taken out of it altogether? is it possible to provide compassionate care to people you think kind of deserve what they got?
i think it can be done. but we shall see.
Monday, October 22, 2012
active shooter
today, i feared for my life.
we were in the middle of a mass casualty situation. the hospital was on high alert. we were discharging people to open up beds, and the ICU was dumping out to make room for the criticals. at this point, we didn't know much. there was an active shooter at an outside location. 7-10 injured, all coming to us. suspect still at large.
i saw my patients and was settling my ICU transfer when the call came out over the loud speaker. they named off the code for 'dangerous situation', followed by the very urgent "THIS IS NOT A DRILL. REPEAT, THIS IS NOT A DRILL".
and all at once, it was my nightmare come true.
the shooter was in the hospital.
as luck would have it, i sat through an active shooter class a month ago. "active shooters are like water", the instructor said, "they take the path of least resistance".
they showed us this. it gave me goosebumps. they played a video reenactment of the columbine shooting. i almost had to get up and walk out.
at the time, i made my plan in my head. of all the choices (run, hide, engage) i knew that i would hide. and it's true what they say: what you practice is what you remember. so i did what i did all those times in my head. pick a patient to stay with. make sure the shooter can't get in.
i went into the room of my ICU transfer. i shoved a chair underneath the door handle, then proceeded to push all of the furniture in the room against the chair. i closed the blinds. and i waited.
i waited for the gunshots and the screaming that would tell me the shooter was on our floor.
and i expected them to come, but they didn't. i busied myself around the room, first assessing, then charting. i called a coworker, she was watching the hallway with several others.
you couldn't have paid me enough to stand and wait for a man with a machine gun to come around the corner.
but after 20 minutes with still no gunshots and no screaming, i felt guilty about my other patients. slowly i moved the furniture from the door. i peeked out into the hall. i quickly moved to my other rooms, hugging the walls and looking over my shoulder for a man with a gun.
stay in your rooms, i told them. just to be safe.
the hospital was swept floor by floor, room by room.
no shooter.
the news was all over the place. they kept repeating the name of the hospital, reminding everyone that there was a possibility he would come to find the victims. repeating the phrase "lockdown". no one in, no one out. one channel said that he had possibly been seen in the cafeteria.
the sweep continued. nothing. then the news: the shooter was dead. found at the primary scene, a suicide.
the shooter had never been in the hospital at all.
so many feelings. relief. embarrassment for being so scared. resentment towards the system that allowed us to think that our lives were in jeopardy, a system that has no way to differentiate between a possible active shooter and sure threat.
and what i did, i think that i would do again. i'm not ashamed for feeling a legitimate fear, for trying to survive when i thought that i was truly in danger.
the hospital is usually my safe and familiar place, and today it wasn't. it's a harsh reality, and sad to come to terms with the fact that you really aren't safe anywhere. at church, at the grocery store, getting your nails done...people living their everyday lives are perfect targets for this type of sick violence.
and it's going to take me a while to stop thinking of myself as a sitting duck.
we were in the middle of a mass casualty situation. the hospital was on high alert. we were discharging people to open up beds, and the ICU was dumping out to make room for the criticals. at this point, we didn't know much. there was an active shooter at an outside location. 7-10 injured, all coming to us. suspect still at large.
i saw my patients and was settling my ICU transfer when the call came out over the loud speaker. they named off the code for 'dangerous situation', followed by the very urgent "THIS IS NOT A DRILL. REPEAT, THIS IS NOT A DRILL".
and all at once, it was my nightmare come true.
the shooter was in the hospital.
as luck would have it, i sat through an active shooter class a month ago. "active shooters are like water", the instructor said, "they take the path of least resistance".
they showed us this. it gave me goosebumps. they played a video reenactment of the columbine shooting. i almost had to get up and walk out.
at the time, i made my plan in my head. of all the choices (run, hide, engage) i knew that i would hide. and it's true what they say: what you practice is what you remember. so i did what i did all those times in my head. pick a patient to stay with. make sure the shooter can't get in.
i went into the room of my ICU transfer. i shoved a chair underneath the door handle, then proceeded to push all of the furniture in the room against the chair. i closed the blinds. and i waited.
i waited for the gunshots and the screaming that would tell me the shooter was on our floor.
and i expected them to come, but they didn't. i busied myself around the room, first assessing, then charting. i called a coworker, she was watching the hallway with several others.
you couldn't have paid me enough to stand and wait for a man with a machine gun to come around the corner.
but after 20 minutes with still no gunshots and no screaming, i felt guilty about my other patients. slowly i moved the furniture from the door. i peeked out into the hall. i quickly moved to my other rooms, hugging the walls and looking over my shoulder for a man with a gun.
stay in your rooms, i told them. just to be safe.
the hospital was swept floor by floor, room by room.
no shooter.
the news was all over the place. they kept repeating the name of the hospital, reminding everyone that there was a possibility he would come to find the victims. repeating the phrase "lockdown". no one in, no one out. one channel said that he had possibly been seen in the cafeteria.
the sweep continued. nothing. then the news: the shooter was dead. found at the primary scene, a suicide.
the shooter had never been in the hospital at all.
so many feelings. relief. embarrassment for being so scared. resentment towards the system that allowed us to think that our lives were in jeopardy, a system that has no way to differentiate between a possible active shooter and sure threat.
and what i did, i think that i would do again. i'm not ashamed for feeling a legitimate fear, for trying to survive when i thought that i was truly in danger.
the hospital is usually my safe and familiar place, and today it wasn't. it's a harsh reality, and sad to come to terms with the fact that you really aren't safe anywhere. at church, at the grocery store, getting your nails done...people living their everyday lives are perfect targets for this type of sick violence.
and it's going to take me a while to stop thinking of myself as a sitting duck.
Sunday, October 21, 2012
timing is everything
the floor is ridiculous lately...everyone on the bed alarm, sitters galore, super sick 1:1 ICUesque patients with plasmapheresis and chemo that have some how ended up with us, etc etc etc. today we were down 2 nurses at shift change and running our asses off when the ICU called up a patient to our only open bed. i had the nurse on one phone, our unit secretary on the other, and three other people in line waiting for things from me.
"i just got the page, i don't know who's going to be taking the patient, can i call you back?"
the ICU nurse was fine, told me she'd call back after lunch. half hour later the secretary called and told me the transfer was cancelled. why?
the patient coded.
crisis averted. narrowly.
"i just got the page, i don't know who's going to be taking the patient, can i call you back?"
the ICU nurse was fine, told me she'd call back after lunch. half hour later the secretary called and told me the transfer was cancelled. why?
the patient coded.
crisis averted. narrowly.
Thursday, October 18, 2012
stay home and die
so i'm pretty much over people who like to be sick.
you don't want to take care of yourself? fine. don't. but don't come to the hospital and make your problems mine.
seriously, i'm done bending over backwards for people who just don't give a damn. from now on, i'm telling you what you need to do and why, and if you don't want to put forth any effort to, i don't know, LIVE, i'm not going to put any effort into you.
oh, so you're in the hospital for DKA and find it necessary to try and order about 20 carbs on your tray? and you just happen to be 38 years old and up ad lib, yet somehow have a stage 3 pressure ulcer on your butt? this completely baffles me. and sure enough, despite the fact that this patient was unwilling to do a single thing to try and not die, she somehow wheedled her way into staying an entire weekend beyond when she should have been discharged. and then, five minutes before she was set to go home she got "sudden" "10/10" "stabbing" chest pain. that was "radiating down her left arm". ok miss negative cardiac workup, you're gonna have to try again. and after numerous sessions with the diabetes team, an hour going over discharge med instructions, and basically free insulin, guess who couldn't be bothered to go fill her insulin prescription? that's right.
and do you know who couldn't be bothered to care? me. because if this lady wants to go home and suck down mountain dew all day until she's in a coma, who am i to stop her?
another patient, in for constipation but refusing meds. refusing to get up and walk. refusing to follow her diet. intermittently refusing dialysis. because "i know my body" and "you all are trying to keep me sick".
here's a thought: if you don't want to follow medical advice, DON'T BOTHER COMING TO A HOSPITAL. if you think that we are trying to kill you at this hospital, go elsewhere. PLEASE.
and despite the fact that we are all horrible people who treat this woman badly and are trying to make sure she doesn't get better so we can make money, she continues to return to our facility. she comes in, refuses to do a thing we say, and then refuses to go home. yes, that's right, she's on the phone with everyone from her sister to patient relations claiming that we are "unlawfully discharging her", despite the fact that she's not doing a single thing here that she couldn't be doing at home, namely ABSOLUTELY NOTHING. oh, and then when she finally did agree to leave, she walked herself down to the ER and checked herself in, because "they did nothing to fix my pain".
listen here bia. you want to shoot up IV pain meds all day then sit like a lump in your bed and refuse laxatives and wonder why you look 5 months pregnant, do it on your own time. i'll spend my time with people who would actually like to get better.
i'm going to start a new public service ad campaign, and it's going to be called 'stay home and die'.
bottom line: do what it takes to get better in the hospital. work with therapy. take your meds. follow your diet. get better, go home, don't come back. if you don't want to do any sort of work, or follow the advice of medical professionals, or you would just prefer to come to the hospital and make a sport of terrorizing the nursing staff and wallowing in learned helplessness STAY HOME AND DIE, and spare me the trouble of watching you ride the slow train to suicide.
this message brought to you by a nurse who's sick of your crap.
you don't want to take care of yourself? fine. don't. but don't come to the hospital and make your problems mine.
seriously, i'm done bending over backwards for people who just don't give a damn. from now on, i'm telling you what you need to do and why, and if you don't want to put forth any effort to, i don't know, LIVE, i'm not going to put any effort into you.
oh, so you're in the hospital for DKA and find it necessary to try and order about 20 carbs on your tray? and you just happen to be 38 years old and up ad lib, yet somehow have a stage 3 pressure ulcer on your butt? this completely baffles me. and sure enough, despite the fact that this patient was unwilling to do a single thing to try and not die, she somehow wheedled her way into staying an entire weekend beyond when she should have been discharged. and then, five minutes before she was set to go home she got "sudden" "10/10" "stabbing" chest pain. that was "radiating down her left arm". ok miss negative cardiac workup, you're gonna have to try again. and after numerous sessions with the diabetes team, an hour going over discharge med instructions, and basically free insulin, guess who couldn't be bothered to go fill her insulin prescription? that's right.
and do you know who couldn't be bothered to care? me. because if this lady wants to go home and suck down mountain dew all day until she's in a coma, who am i to stop her?
another patient, in for constipation but refusing meds. refusing to get up and walk. refusing to follow her diet. intermittently refusing dialysis. because "i know my body" and "you all are trying to keep me sick".
here's a thought: if you don't want to follow medical advice, DON'T BOTHER COMING TO A HOSPITAL. if you think that we are trying to kill you at this hospital, go elsewhere. PLEASE.
and despite the fact that we are all horrible people who treat this woman badly and are trying to make sure she doesn't get better so we can make money, she continues to return to our facility. she comes in, refuses to do a thing we say, and then refuses to go home. yes, that's right, she's on the phone with everyone from her sister to patient relations claiming that we are "unlawfully discharging her", despite the fact that she's not doing a single thing here that she couldn't be doing at home, namely ABSOLUTELY NOTHING. oh, and then when she finally did agree to leave, she walked herself down to the ER and checked herself in, because "they did nothing to fix my pain".
listen here bia. you want to shoot up IV pain meds all day then sit like a lump in your bed and refuse laxatives and wonder why you look 5 months pregnant, do it on your own time. i'll spend my time with people who would actually like to get better.
i'm going to start a new public service ad campaign, and it's going to be called 'stay home and die'.
bottom line: do what it takes to get better in the hospital. work with therapy. take your meds. follow your diet. get better, go home, don't come back. if you don't want to do any sort of work, or follow the advice of medical professionals, or you would just prefer to come to the hospital and make a sport of terrorizing the nursing staff and wallowing in learned helplessness STAY HOME AND DIE, and spare me the trouble of watching you ride the slow train to suicide.
this message brought to you by a nurse who's sick of your crap.
Wednesday, October 17, 2012
today.
today nothing nothing went right.
the dynamaps were all missing pieces
the computers weren't working or my rooms didn't have them.
everyone was hypertensive.
no one was oriented.
the bed alarms were constant.
we were short a nurse.
there was always a line for my attention.
my phone never stopped ringing.
i was mean to my coworkers.
my assignment was the hardest.
i resented my patients.
i sucked, pretty much.
maybe tomorrow will be better.
maybe not.
but at least it won't be today.
the dynamaps were all missing pieces
the computers weren't working or my rooms didn't have them.
everyone was hypertensive.
no one was oriented.
the bed alarms were constant.
we were short a nurse.
there was always a line for my attention.
my phone never stopped ringing.
i was mean to my coworkers.
my assignment was the hardest.
i resented my patients.
i sucked, pretty much.
maybe tomorrow will be better.
maybe not.
but at least it won't be today.
Sunday, October 14, 2012
trouble is a friend
it was a weird morning. rainy and humid and oddly warm for october. i was chatting with my nurse friend and drinking coffee. we were on the way to church. i was driving. i don't remember what was on the radio, i don't remember what we were talking about. i also don't remember seeing the red car in front of us spin out, and i don't know how i managed to slam on my brakes fast enough to avoid hitting anyone.
somehow i ended up on the side of the road. we went to go see if everyone was alright. another driver pulled over too, and called 911. the driver of the red car was gushing blood from his head. seriously, it was like Carrie. i grabbed a pair of gloves from the glove compartment of my car. my first aid kit had a 2x2 gauze in it...which was sad and useless. i grabbed the only other thing i could find (a blue isolation gown), and held pressure to the driver's head.
for the record, blue isolation gowns are water-repellant and worthless for gushing head wounds.
my nurse friend found some rags in the back of my car, so we switched to that. much better. the bleeding slowed. no LOC, no dizziness, no lightheadedness, and pretty darn calm for someone with blood pouring down his face. "please tell me you're a nurse", he said. why as a matter of fact...
we waited for the ambulance. FOREVER, it felt like, but probably less than 10 minutes. we were on the highway, an overpass just past a big curve. not the best spot to be, but definitely could have been worse.
THANK GOD the pouring rain had stopped. THANK GOD the shoulder was big enough for us to work on. THANK GOD the car wasn't going faster and didn't go over the cement barricade of the overpass. THANK GOD i was with one of my nurse friends.
i have never been so relieved to see a fire truck in all my life. they took over, and our merry band of first responders went on our way. when we left the driver looked pretty good. my guess is a few head staples and he'll be on his way.
and i'm a little emotionally scarred, but no worse for wear. the more i find myself in these kinds of situations, the less shaken i am by them.
that being said, i could go for a quiet weekend every once in awhile.
just saying.
somehow i ended up on the side of the road. we went to go see if everyone was alright. another driver pulled over too, and called 911. the driver of the red car was gushing blood from his head. seriously, it was like Carrie. i grabbed a pair of gloves from the glove compartment of my car. my first aid kit had a 2x2 gauze in it...which was sad and useless. i grabbed the only other thing i could find (a blue isolation gown), and held pressure to the driver's head.
for the record, blue isolation gowns are water-repellant and worthless for gushing head wounds.
my nurse friend found some rags in the back of my car, so we switched to that. much better. the bleeding slowed. no LOC, no dizziness, no lightheadedness, and pretty darn calm for someone with blood pouring down his face. "please tell me you're a nurse", he said. why as a matter of fact...
we waited for the ambulance. FOREVER, it felt like, but probably less than 10 minutes. we were on the highway, an overpass just past a big curve. not the best spot to be, but definitely could have been worse.
THANK GOD the pouring rain had stopped. THANK GOD the shoulder was big enough for us to work on. THANK GOD the car wasn't going faster and didn't go over the cement barricade of the overpass. THANK GOD i was with one of my nurse friends.
i have never been so relieved to see a fire truck in all my life. they took over, and our merry band of first responders went on our way. when we left the driver looked pretty good. my guess is a few head staples and he'll be on his way.
and i'm a little emotionally scarred, but no worse for wear. the more i find myself in these kinds of situations, the less shaken i am by them.
that being said, i could go for a quiet weekend every once in awhile.
just saying.
Sunday, October 7, 2012
there are worse ways than this
she was dying, and there was nothing to do about it. she was septic from complications of a procedure. she was developmentally delayed, wheelchair bound, and had no family. her guardian decided it was time for palliative care, and we agreed.
making people comfortable is my favorite. people like to get all warm fuzzy about nurses having "a touch that never hurts". my touch hurts all the time. whether it's the heparin shot in the belly, the painful dressing change, the deep breathing or the ambulation that i insist on...i make people do things that hurt every day. i do it to make them better.
until we can't make them better. and then we just do nice things.
i covered her in a handmade quilt and wrapped a prayer shawl around her shoulders. she held the knitted bear that a volunteer had made. the people from her facility brought her things, and i read to her from her favorite books. i lotioned her hands and feet, and put her lip balm on her. i talked to her, sat with her, and played soothing music for her. i pushed her pain button for her, and i gave her lots of meds to dry up her ever-increasing secretions and to keep her fever at bay.
i cried for her, but they weren't sad tears. because where she had looked so uncomfortable before, she was now at peace.
i have seen horrible ways to die. this? is not that.
if there is a good way to go, this is it. in a quiet space, with someone at your side. surrounded by familiar smells, with familiar things.
there is a time to fight, and there is a time to give in. to let go. and she did, at 0320, with the night nurses by her side.
knowing that she was comfortable and well-cared for until the end, i'm at peace. and so, thankfully, is she.
making people comfortable is my favorite. people like to get all warm fuzzy about nurses having "a touch that never hurts". my touch hurts all the time. whether it's the heparin shot in the belly, the painful dressing change, the deep breathing or the ambulation that i insist on...i make people do things that hurt every day. i do it to make them better.
until we can't make them better. and then we just do nice things.
i covered her in a handmade quilt and wrapped a prayer shawl around her shoulders. she held the knitted bear that a volunteer had made. the people from her facility brought her things, and i read to her from her favorite books. i lotioned her hands and feet, and put her lip balm on her. i talked to her, sat with her, and played soothing music for her. i pushed her pain button for her, and i gave her lots of meds to dry up her ever-increasing secretions and to keep her fever at bay.
i cried for her, but they weren't sad tears. because where she had looked so uncomfortable before, she was now at peace.
i have seen horrible ways to die. this? is not that.
if there is a good way to go, this is it. in a quiet space, with someone at your side. surrounded by familiar smells, with familiar things.
there is a time to fight, and there is a time to give in. to let go. and she did, at 0320, with the night nurses by her side.
knowing that she was comfortable and well-cared for until the end, i'm at peace. and so, thankfully, is she.
Wednesday, October 3, 2012
curses on me, apparently.
today it took me 4 IV pumps and 2 sets of tubing to set up maintenance fluids.
and it took me 3 dynamaps to get a set of vitals, seeing as how each one is missing a key part.
and then i got electrocuted trying to plug the computer in. literally electrocuted, like electricity buzzing through my fingers. it was terrifying.
i fear someone may have a voodoo doll of me somewhere.
and it took me 3 dynamaps to get a set of vitals, seeing as how each one is missing a key part.
and then i got electrocuted trying to plug the computer in. literally electrocuted, like electricity buzzing through my fingers. it was terrifying.
i fear someone may have a voodoo doll of me somewhere.
Thursday, September 27, 2012
caring too much
i care a lot about what other people think about me. this is a flaw. when i became a nurse, it took me a long time to accept that not everyone would instantly love me, that some might not even like me at all. if you would have told me that people would sometimes yell at me, tell me i'm not good at my job, and fire me, i wouldn't have believed it. because i am likeable, and friendly, and am someone who will bend over backwards for approval.
or i guess i should say i was.
i have become mean.
it makes sense why. every day i go to work and am essentially told 'do better'. there's always some issue: entitled patients, arrogant doctors, crap staffing, some new policy that takes yet another resource way from us. and it sucks. so bad. and no coping mechanism that i have seems to be acceptable.
first when i was frustrated i cried. then everyone thought that i had mental health issues and looked at me like i was scaring them and all my evals would say things like "find ways to cope with stress". well crying WAS my was of coping, but i got tired of everyone else thinking i was crazy, so i tried to minimize the waterworks and tried to talk out my feelings. vent, so to speak.
ok, so maybe it was ranting. whatever.
but that is "negative" and "a bad influence on new staff", and if i am frustrated i'm supposed to "take a moment to myself to collect my thoughts and carry on". yes, because i have so much time for contemplative moments.
so, i shouldn't be crying out my feelings, and it's is forbidden to express my frustrations out loud, so i'll swallow them all instead. (not literally, although i tried that too. gaining 20 pounds doesn't make anybody feel any better, for the record.) so what am i left with? i'm just supposed to suck it up, all the time.
lets practice:
oh, we're short a nurse and all of our techs have to be sitters today? great!!
you're sending me a patient who is in 4 point restraints and has been getting ativan regularly? fun!! i can't wait!! and you plan on DCing all the benzos? i love a challenge!!
ooo, you've come up with another form to fill out to record productivity? i'll look forward to completing this q shift, as per policy!!
i want to punch everyone in the face. i'm not allowed to cry, i'm not allowed to express my frustrations to my coworkers, i'm not allowed to say how crappy it is to work here in the staff meetings, i'm not allowed to tell my patients that they can't have 234 juices for all their babies and baby mommas, i'm not allowed to tell the director that i think she's nuts for thinking that people 'have a lot of respect for the healthcare system and don't bring guns to the hospital', i'm not allowed to tell trauma that they're a bunch of idiots this month, and i'm not allowed to tell their chief residents that they're bitches. i'm not allowed to have any emotions on the outside at all, apparently. but on the inside i am a big ball of ranty angst, and it stews and it stews until it bubbles up and i can't stop it.
but that makes people think that i actually am evil and awful and mean, and i don't like that either.
i have a nursing student this semester and all i can think about is how i'm poisoning the future. who on earth would want to become a nurse after seeing how crazy this job has made me?
how do i stop caring too much about the stupid things, like what people think of me? and how do i start caring about the important things, like how to be nice again? and i what do i do with the feelings of wrath?
this job has made me different. it has made me strong, in a lot of ways. but i don't want it to make me hard. i obsess about silly things, i easily forget to be compassionate, i'm frustrated almost all of the time, and i care too much about what other people think.
i might care too much, but at least i still care.
i still care. so maybe the kindness that used to come so easily to me is buried somewhere underneath four years of day-to-day dealings with humanity. and maybe i can still find it.
it makes sense why. every day i go to work and am essentially told 'do better'. there's always some issue: entitled patients, arrogant doctors, crap staffing, some new policy that takes yet another resource way from us. and it sucks. so bad. and no coping mechanism that i have seems to be acceptable.
first when i was frustrated i cried. then everyone thought that i had mental health issues and looked at me like i was scaring them and all my evals would say things like "find ways to cope with stress". well crying WAS my was of coping, but i got tired of everyone else thinking i was crazy, so i tried to minimize the waterworks and tried to talk out my feelings. vent, so to speak.
ok, so maybe it was ranting. whatever.
but that is "negative" and "a bad influence on new staff", and if i am frustrated i'm supposed to "take a moment to myself to collect my thoughts and carry on". yes, because i have so much time for contemplative moments.
so, i shouldn't be crying out my feelings, and it's is forbidden to express my frustrations out loud, so i'll swallow them all instead. (not literally, although i tried that too. gaining 20 pounds doesn't make anybody feel any better, for the record.) so what am i left with? i'm just supposed to suck it up, all the time.
lets practice:
oh, we're short a nurse and all of our techs have to be sitters today? great!!
you're sending me a patient who is in 4 point restraints and has been getting ativan regularly? fun!! i can't wait!! and you plan on DCing all the benzos? i love a challenge!!
ooo, you've come up with another form to fill out to record productivity? i'll look forward to completing this q shift, as per policy!!
i want to punch everyone in the face. i'm not allowed to cry, i'm not allowed to express my frustrations to my coworkers, i'm not allowed to say how crappy it is to work here in the staff meetings, i'm not allowed to tell my patients that they can't have 234 juices for all their babies and baby mommas, i'm not allowed to tell the director that i think she's nuts for thinking that people 'have a lot of respect for the healthcare system and don't bring guns to the hospital', i'm not allowed to tell trauma that they're a bunch of idiots this month, and i'm not allowed to tell their chief residents that they're bitches. i'm not allowed to have any emotions on the outside at all, apparently. but on the inside i am a big ball of ranty angst, and it stews and it stews until it bubbles up and i can't stop it.
but that makes people think that i actually am evil and awful and mean, and i don't like that either.
i have a nursing student this semester and all i can think about is how i'm poisoning the future. who on earth would want to become a nurse after seeing how crazy this job has made me?
how do i stop caring too much about the stupid things, like what people think of me? and how do i start caring about the important things, like how to be nice again? and i what do i do with the feelings of wrath?
this job has made me different. it has made me strong, in a lot of ways. but i don't want it to make me hard. i obsess about silly things, i easily forget to be compassionate, i'm frustrated almost all of the time, and i care too much about what other people think.
i might care too much, but at least i still care.
i still care. so maybe the kindness that used to come so easily to me is buried somewhere underneath four years of day-to-day dealings with humanity. and maybe i can still find it.
Monday, September 24, 2012
your job: you're doing it wrong.
typical ED exchange, and proof for my theory that our ED nurses are actually unlicensed homeless personnel and/or circus monkeys:
me: what's the medical history?
ED RN: elevated PSA, basal cell carcinoma, arthritis... (in snotty voice) you know i'm just reading all this, it's in the computer.
me: okaaaaay.
patient comes up, and we're reviewing the medical history. which is "in the computer"...until we get to the reason that he's actually here. a complication from a recent surgery.
a whipple.
not in the computer, for the record.
the whipple: a major surgery in which basically everything gets removed and/or reconnected...stomach, gallbladder, pancreas, duodenum, etc. etc.
huge surgery, kind of a big deal. definitely worth mentioning and/or charting on, definitely something i would have liked to know about.
and it would be nice to know that the patient is one of the chief of surgery's privates, as he is very particular and likely to throw things should we violate one of his unwritten rules.
and it would be nice for the patient to be admitted under the correct service, which he isn't.
and it would be nice for the patient to be admitted to the correct floor, which he also isn't.
circus. monkeys. i rest my case.
me: what's the medical history?
ED RN: elevated PSA, basal cell carcinoma, arthritis... (in snotty voice) you know i'm just reading all this, it's in the computer.
me: okaaaaay.
patient comes up, and we're reviewing the medical history. which is "in the computer"...until we get to the reason that he's actually here. a complication from a recent surgery.
a whipple.
not in the computer, for the record.
the whipple: a major surgery in which basically everything gets removed and/or reconnected...stomach, gallbladder, pancreas, duodenum, etc. etc.
huge surgery, kind of a big deal. definitely worth mentioning and/or charting on, definitely something i would have liked to know about.
and it would be nice to know that the patient is one of the chief of surgery's privates, as he is very particular and likely to throw things should we violate one of his unwritten rules.
and it would be nice for the patient to be admitted under the correct service, which he isn't.
and it would be nice for the patient to be admitted to the correct floor, which he also isn't.
circus. monkeys. i rest my case.
Thursday, September 20, 2012
and they wonder why we're all burnt out.
i like to do things correctly. i like them to be neat, and finished. my life at work is barely organized chaos on the best of days, and surviving on a wing and prayer the rest of the time. i will never be good enough for management, or JCAHO, or CMS, and i have to learn to accept this.
the hospital is never going to be clean enough. i am tidying patient rooms on "clutter rounds" and wiping down the computers daily and meticulously recording it on a paper log. because i have to. or else there will be "corrective action".
i am now responsible for IM notices and some other government mandated mumbo jumbo about people refusing to be discharged. if i don't give them out, there will also be "corrective action".
it's not quiet enough and patients don't feel that they are being listened to enough, and the call lights aren't being answered soon enough and patients aren't receiving help as fast as they would like, and communications with the care team are dismal, and also the HCAPS and the report cards are not at the median line and we are in yellow and red or something like that.
our aides are dissatisfied because they are not getting lunches and they are complaining. and instead of getting more aides so they don't each have to care for 16 patients, nurses need to stop delegating so much stuff. except for last month, in which we were told to delegate because we are punching out too late and it costs money.
and then there are the cultural competence online modules and the ever-popular "de-escalation training". this will be mandatory. well, only if you want a raise next year, that is.
and also i need to complete the advanced nursing pathway because we need 4 people to do it by next year. not to worry, this involves only 20 hours of continuing education. and a poster project to a group. and a research study. and that i precept 100 hours this semester.
which i do, by the way.
i precept: one on one with a student nurse and then for weeklong stretches with new grads. i'm charge nurse, which we do while taking a full patient assignment. i field questions from the new nurses, and am a resource person. all the nurses on my shift are new, by the way. with the exception of one other nurse, everyone has been on the floor for less than a year.
and then there are the nursing students, 4 different groups on 4 different days every week this semester. we are responsible for teaching them too.
i head a council, for which i am supposed to attend a monthly house-wide meeting. then i am to run 3 floor meetings monthly. then i meet with the heads of the other councils monthly. there must be typed minutes that are approved a week before for all of this. and projects. no one wants to do projects, however, so i do most of them myself.
and then there is the bedside shift report, which is not getting done and we should all be ashamed of ourselves.
and the hourly rounding, we have to do that too, or the Studer group says all our patients will fall and die.
and we all must attend the mandatory interdisciplinary rounds. well mandatory for nursing, i guess, but not for the physician representatives. they couldn't possibly be bothered to come and discuss their patients, because they're busy.
and i clearly have all the time in the world.
it's too much, too much for my brain to even hold and definitely too much to expect from a person. because those are just the "extras" in my mind. i also have to assess, medicate, monitor, and nurture 4-5 patents too. to maintain tubes, to suction trachs, to change dressings and ambulate and bolus and make sure that there is enough urine and that the blood pressure isn't too high and that trauma isn't about to wreck kidneys with IV anti-inflammatories. and then i need to keep track of all that data by charting the assessments, fall risks, braden scales, IVs, wounds, pain assessments and reassessments, neuro checks, CIWA scales, and sitter scores. oh and do care plans and patient education too.
i can't do it all, but it is all "an expectation". and failing to do any of the above comes with "corrective action" and "negative consequences".
i don't care about half this stuff, and i care probably twice as much as most people on the floor.
so what do you do when you can't do it all?
the best you can, i guess.
Thursday, September 13, 2012
the bizarre story of ringo
ringo* came to me on a crazy august night. he was completely wasted, belligerent, and 'not cooperative with the plan of care' so to speak. i first met him when i answered the call for help from several of my coworkers who were trying to keep a very rowdy ringo in bed. he insisted that he could walk to the bathroom, which he did, bouncing off of the IV pole and several walls as he went. he was a huge man, tall and solid, and my tiny coworkers were no match for him. as hard as the three of us tried, we couldn't get him to go back to bed. it took 5 of our finest security guards to get ringo in bed, and 4 point restraints to keep him there. as my name badge was the only one he had seen, he screamed my name at the top of his lungs repeatedly, until the haldol finally kicked in and he passed out. turns out ringo had stolen his "roommate's" moped, gotten ridiculously drunk/high, and crashed it into a bunch of parked cars. he had a couple of brain bleeds, a couple of broken bones, but was pretty much in one piece.
turns out ringo was actually a decent human being sober, although a little overly friendly. i took over as his nurse the next day and as long as i avoided his grabby hands, we got along fine.
he had nowhere to go, as is pretty common on the trauma unit. he had been bouncing around sleeping on friends couches and in his car. unfortunately, brain injured patients can't be discharged to nowhere, and although ringo was desperate to leave, he had to stay almost two weeks.
word came via social work that ringo's "roommate" with the stolen moped was willing to welcome him back with open arms. odd indeed, but i packed him up and sent him on his way.
not 24 hours later, guess who's back in the ED?
surprise, surprise.
now we are no strangers to discharges/readmits. it happens all the time...wound infections, bowel obstructions, etc etc. so i was shocked to read in the ED notes that ringo was being readmitted for a NEW problem.
namely, he got the beat down.
that's right, he was discharged and readmitted the next day after being found down in an alley with a GCS of 3. he ended up with a new brain bleed on top of his old ones, and several new fractures. he was IDed in the trauma bay by the surgical chief resident, who recognized him from his previous stay.
he was admitted to the floor, and we picked up right where we left off, like we were in some sort of bizarre hospital time warp. he claimed not to remember what had happened, and tried to tell his sister that he "fell".
yeeeeeeah. ok.
my guess? those open arms of his now moped-less "roommate" turned out to be closed fists.
so that's the bizarre story of ringo, who managed to rack up two traumas in two weeks. may his brain cells rest in peace.
* names have been changed to protect patient privacy, as have the details of this little narrative. so hippa nazis can go 'head and step off
turns out ringo was actually a decent human being sober, although a little overly friendly. i took over as his nurse the next day and as long as i avoided his grabby hands, we got along fine.
he had nowhere to go, as is pretty common on the trauma unit. he had been bouncing around sleeping on friends couches and in his car. unfortunately, brain injured patients can't be discharged to nowhere, and although ringo was desperate to leave, he had to stay almost two weeks.
word came via social work that ringo's "roommate" with the stolen moped was willing to welcome him back with open arms. odd indeed, but i packed him up and sent him on his way.
not 24 hours later, guess who's back in the ED?
surprise, surprise.
now we are no strangers to discharges/readmits. it happens all the time...wound infections, bowel obstructions, etc etc. so i was shocked to read in the ED notes that ringo was being readmitted for a NEW problem.
namely, he got the beat down.
that's right, he was discharged and readmitted the next day after being found down in an alley with a GCS of 3. he ended up with a new brain bleed on top of his old ones, and several new fractures. he was IDed in the trauma bay by the surgical chief resident, who recognized him from his previous stay.
he was admitted to the floor, and we picked up right where we left off, like we were in some sort of bizarre hospital time warp. he claimed not to remember what had happened, and tried to tell his sister that he "fell".
yeeeeeeah. ok.
my guess? those open arms of his now moped-less "roommate" turned out to be closed fists.
so that's the bizarre story of ringo, who managed to rack up two traumas in two weeks. may his brain cells rest in peace.
* names have been changed to protect patient privacy, as have the details of this little narrative. so hippa nazis can go 'head and step off
Monday, September 10, 2012
bffs
i don't want to get all emo up in here, but i swear most days nobody gets me. people think that nursing is
a. easy
b. a good way to make a lot of money (haha)
or
c. like working in a doctor's office.
thank god for my fabulous, amazing, very talented nurse (and real life) bff. she and i have been through everything together...the first horrid, cry-all-day-everyday years of being a nurse...the first awful PTSD-inducing codes...the first time a doctor gave a stupid order...all of it. she makes me laugh until i cry, and i recently dug up some fabulous emails that detail our trials. please excuse me while i go pee my pants.
dearest friend,
lawdhelpmejesusimabouttolosemy
$24 to pay your copay, but you have enough money to pay for your
cocaine. i hate my patient today, and when they turn {the hospital} into some
holistic + integrative medicine hotel, it's going to be worse. okay.
well, time to go slap some bitches
to which i reply:
my advice on the person who wants you to give him $24? give it to him, it will make him go away. this is sad. tgisunday, and drink up.
she also understands my frustrations on the day to day hassles of nursing. and she's way more descriptive than i am :)
begin rant.
i hate my job. i hate my job. i hate my job. i hate my job. i hate my
job. i hate my job. i hate my job. I HATE MY JOB. I HATE MY JOB. I
HATE MY JOB!!!!!!!! seriously, i do.
i hate {new computer system}.
i hate my patients. especially my icu tx. A*HOLE.
totalm*f*a*hole. just told me that i want him to stay sick
because i'm afraid i'm going to lose my job. this is said between
labored respirations at 32/minute, because i said he can't shower.
seriously.
i hate doctors, too. they're lazy.
i hate how pharmacy can't send meds up under {new computer system}.
i hate how the kitchen doesn't send trays.
i hate how blood sugars and vitals dont get charted.
i hate how i get attitude when i ask for things.
i hate when all my meds are missing, so everything is late. and i have
to do twice the work to find them, and then find time to go give them
again.
i hate how icu lied about supplementing potassium before transferring.
i hate how there are now no orders for potassium, and i have to call
the dr. for the billionth time to try and find some.
i hate how i started with 5 patients, sent someone home, and had to
pick up someone else by 1545 so we could send a nurse home because we
were overstaffed.
i hate this s*.
seriously.
i am going to drink all weekend.
and i wish i could start now.
but that's illegal, and i'd lose my job. but right now, that would be
a blessing.
oh, look what time it is. it's f*thiss* o'clock.
i'm going to go eat now. and turn my phone off. if anybody is looking
for me, they can go to hell.end rant.
truth. every word.
so in summary, god bless fabulous, amazing, very talented nurse (and real life) bff. and may she never have to hear the phrase "curds of whey" ever again. amen.
a. easy
b. a good way to make a lot of money (haha)
or
c. like working in a doctor's office.
thank god for my fabulous, amazing, very talented nurse (and real life) bff. she and i have been through everything together...the first horrid, cry-all-day-everyday years of being a nurse...the first awful PTSD-inducing codes...the first time a doctor gave a stupid order...all of it. she makes me laugh until i cry, and i recently dug up some fabulous emails that detail our trials. please excuse me while i go pee my pants.
dearest friend,
lawdhelpmejesusimabouttolosemy
$24 to pay your copay, but you have enough money to pay for your
cocaine. i hate my patient today, and when they turn {the hospital} into some
holistic + integrative medicine hotel, it's going to be worse. okay.
well, time to go slap some bitches
to which i reply:
my advice on the person who wants you to give him $24? give it to him, it will make him go away. this is sad. tgisunday, and drink up.
she also understands my frustrations on the day to day hassles of nursing. and she's way more descriptive than i am :)
i hate my job. i hate my job. i hate my job. i hate my job. i hate my
job. i hate my job. i hate my job. I HATE MY JOB. I HATE MY JOB. I
HATE MY JOB!!!!!!!! seriously, i do.
i hate {new computer system}.
i hate my patients. especially my icu tx. A*HOLE.
totalm*f*a*hole. just told me that i want him to stay sick
because i'm afraid i'm going to lose my job. this is said between
labored respirations at 32/minute, because i said he can't shower.
seriously.
i hate doctors, too. they're lazy.
i hate how pharmacy can't send meds up under {new computer system}.
i hate how the kitchen doesn't send trays.
i hate how blood sugars and vitals dont get charted.
i hate how i get attitude when i ask for things.
i hate when all my meds are missing, so everything is late. and i have
to do twice the work to find them, and then find time to go give them
again.
i hate how icu lied about supplementing potassium before transferring.
i hate how there are now no orders for potassium, and i have to call
the dr. for the billionth time to try and find some.
i hate how i started with 5 patients, sent someone home, and had to
pick up someone else by 1545 so we could send a nurse home because we
were overstaffed.
i hate this s*.
seriously.
i am going to drink all weekend.
and i wish i could start now.
but that's illegal, and i'd lose my job. but right now, that would be
a blessing.
oh, look what time it is. it's f*thiss* o'clock.
i'm going to go eat now. and turn my phone off. if anybody is looking
for me, they can go to hell.end rant.
truth. every word.
she also is one of the only people i know who has patients who are equally as/more repulsive than my own. as is evidenced by:
this evening i had the pleasure of admitting a darling 40 year old woman for weakness, dizziness and syncope from the er. she's schizo, htn, dm2, ckd, asthma, seizures (and not the 'seize the day' kind), smoker, cva with left residual, in contact for hx mrsa and r/o cdiff. oh, and she's just plain weird. lives at a rooming house, her "fiance" is homeless (and thankfully left to head to {the shelter} for dinner, but came back with bloodshot eyes..hmmm....wonder where he detoured for a little something special). when i walked in and introduced myself, and asked her how she was, of course her reply was "i'm hungry. and i'm not going to eat a diabetic diet. i need to eat sour cream." ummm....okay, good to see you, too, ma'am. and sour cream? wtf. so, she had a seizure at 0400 and has been having diarrhea x a month. yep, a month of daily diarrhea without the need to go to the doctor. she's orthostatic with lying bps 90/50, sitting 70/40...a bit dehydrated. anyways, you get the idea. she's nuts. and she's kinda sick. but mostly just nuts. so, when i'm doing her admission database, i have to ask her about her meds (in addition to safety, which she says she doesn't feel safe because whenever she goes to the bathroom at her rooming house - so she goes with the door open - her roommates dry to steal her vicodins...anyways). so, when i ask her about her meds, she tells me she doesn't take them. when i ask her why, she says "well. i'm too lazy to walk to walgreens to pick them up." seriously? so, because you can't walk your crazy ass to walgreens to pick.up.your.seizure.meds. i have to admit and pay for your hospital stay? when i offered that she take the bus, she informed me that she "ain't gonna waste $2.25 on a bus ticket". but she can waste her money on a pack of cigs a day? f*. that s* pisses me off.
so, then i have to give her some diflucan. guess why? oh, yah. she's itchy. down in lady town. i just wanted to give her the pills and get out of her room, but she felt the need to tell me...and i quote..."well, yesterday i was itchy down there, so i put my finger in it, and when i took it out it had curds of whey on it". take a moment to barf, please. THESE PEOPLE ARE INSANE. and she says this all with a blank stare. how am i not supposed to 1. barf, 2. laugh or 3. cry with these people.
see?
Thursday, September 6, 2012
more ridiculousness
i've seen a lot of things, this we know is true.
but i've never seen a patient flip off an entire team of neurosurgeons while they're trying to explain the C-spine surgery they have planned for him. and i've never seen a patient sign his name on a consent form, followed by the words "f*** off".
a bit of advice: if you plan on being an ass to your surgeon, you should start after they perform the delicate procedure that could very well leave you paralyzed and on a vent.
just a thought.
Wednesday, September 5, 2012
ridiculousness.
hard to say what the high point of ridiculousness was today. perhaps it was the man going through full blown DTs with the rude, condescending resident who thought that he didn't need to go to the ICU even though 10 mg of Ativan and 6 beers hadn't touched his full-body tremors and hallucinations. or maybe it was the same resident, who said that the constant trickle of blood from the fresh neck dissection was just "skin level", and wasn't concerned that he was saturating gauze at an alarming rate. oh, i could go on all day about how this particular resident is patronizing and a bit full of herself considering that she's been a doctor for all of two months. and maybe she'll have a come to jesus moment when she realizes that those trauma nurses were onto something with the DTer (ICU-intubated-ativan drip...duh). and maybe she'll realize not to bite the hand that feeds her...aka the hand that tells her exactly which orders to write, which patients she needs to see, and when she needs to ask for help. THAT IS MY HAND. and she'd better learn to recognize.
but i digress. believe it or not, none of these instances were the most ridiculous of the day. that honor goes to the patient's visitor who came to the nurse's station because "i've missed three doses of my vicodin and i'm really getting uncomfortable".
seriously.
the VISITOR.
he expected us to hand him vicodin.
and the sad part is, i'm sure the gods of patient satisfaction will smite us for not running out to the nearest pharmacy to pick some up for him.
and they wonder why we can't keep these people happy.
unreal.
Sunday, September 2, 2012
roll me back in time
today i had a moment -maybe my first- where i felt like i was exactly what my patient needed. she was getting her epidural and freaking out, so i stood in front of her, held both of her hands, and told her to breathe and that she was doing so good. just breathe. i kept her from panicking. no one else was getting it...the anesthesiologist had a job to do, her mom had to leave the room, and the nurse was monitoring her. so i stepped in and got her through it. it was one of the most satisfying things that i've ever done. i was a nurse today, and it was good.
this happened my junior year of college, during my OB clinical. i was so young, but my patient was younger. i still remember her terror, she was on the edge of an epic freak out and i was all that stood between her and blind panic. i knelt down in front of her until my legs went numb and murmured soothing things as the doctor put the ridiculously long epidural needle in her spine. after we got through it, i remember the nurse that i was shadowing looked at me, impressed. that was the first time that i knew that i was really supposed to be a nurse. and on days like these, when i can't remember the last helpful thing that i did and can't focus on anything except how hard this job is, this is something worth remembering.
this happened my junior year of college, during my OB clinical. i was so young, but my patient was younger. i still remember her terror, she was on the edge of an epic freak out and i was all that stood between her and blind panic. i knelt down in front of her until my legs went numb and murmured soothing things as the doctor put the ridiculously long epidural needle in her spine. after we got through it, i remember the nurse that i was shadowing looked at me, impressed. that was the first time that i knew that i was really supposed to be a nurse. and on days like these, when i can't remember the last helpful thing that i did and can't focus on anything except how hard this job is, this is something worth remembering.
Tuesday, August 28, 2012
can i get an amen?
favorite moment from a recent shift: walking in on a family prayer circle for my +ETOH MVC that ended with "...and take the taste of liquor off his tongue, Lord Jesus, and help him get a job. and a new car. AMEN!!"
mmhmm, love me a good prayer.
mmhmm, love me a good prayer.
Wednesday, August 22, 2012
free at LAST, ya'll.
so i had this patient. he's manipulative, has violent mood swings, and can only be described by the term "straight cray". while i put in two large bore IVs, he attempted to stroke my arm, telling me that "my skin was so soft, and so flawless". oh i KNOW YOU DID NOT JUST TOUCH ME. a 20 gauge to the AC made me seem a whole lot less attractive, i'm sure. and maybe if he wouldn't have been screaming and swatting at me while i was trying to get his line in, i wouldn't have accidentally cannulated his artery.
so on to IV number two. during this attempt, the patient is telling me what he and i will do on "our date". apparently we will be going to 'the club', and drinking ciroc. he'll be 'looking all fly like young jeezy' wearing his shirt that was 'a buck fifty' and his 'jordans, 250'. he took great pleasure in describing how he would rub johnson's baby lotion on my shoulders, and i took great pleasure in shoving an 18 gauge into his wrist.
i hadn't mentioned the fact that IV number one was in an artery, yet, and when i did cray cray's tune quickly changed. now all the sudden i'm fired, and he's gearing up to throw the OT shoehorn at my head.
an hour later, i'm "almost back on the christmas list" (oh thank GOD!!!). because he was NPO for a test, he wanted 2 dinners. whatever, if shoving his face with 2 dinners meant he wouldn't be talking to me, i was all for it. but he wouldn't be able to order 2 meals without my assistance, and thus i was presented with THE LIST.
the following is what my patient requested for dinner:
cheeseburger
5 slices bacon
sauteed mushrooms
2 miracle whips
2 salt/peppa
2 slices cheddar cheese
1 slice mozarella
pizza
double cheese/cheddar
ham/pepperoni/sausage
taco salad in a baked shell
lettuce
cheddar cheese
hot sauce
ranch
taco sauce
pepsi and crystal lite lemonade, on ice.
yes. because i spent four years in nursing school to be a glorified waitress.
and after i wasted ten of my precious minutes on hold with dietary and then reciting this ridiculous food order, the patient called down to the kitchen and attempted to order himself ANOTHER food tray, which unfortunately for him cancelled out my order. i'd like to think of that as karma, and it would have been wildly entertaining had my patient not pitched a toddler-esque tantrum over the fact that he was only getting a steak and a chicken leg.
but still i pressed on!! until the unthinkable happened: the patient was made NPO.
and it was like the gates of hell itself flew open.
in a fiery blaze of glory, i was fired (for real this time). i celebrated with a victory lap around the nurse's station complete with fist pumping and a rousing slow clap. it was like heaven smiled on me, and after 9 long days of emotional abuse, manipulation, sexual harassment, and general tomfoolery, i was FREE.
my heart goes out to the coworker who takes my place and enters the lair of this beast. he is truly one of the worst patient's i've ever had, and i'm talking like top 3 here.
i shall close with the words of our nurse's assistant, who had the pleasure of being interviewed by the police after straight cray patient accused her of involvement in his shooting:
"if i'd have done this, he wouldn't be in the hospital. he'd be in the graveyard".
and after putting up with day upon day of his crap, i can agree.
so on to IV number two. during this attempt, the patient is telling me what he and i will do on "our date". apparently we will be going to 'the club', and drinking ciroc. he'll be 'looking all fly like young jeezy' wearing his shirt that was 'a buck fifty' and his 'jordans, 250'. he took great pleasure in describing how he would rub johnson's baby lotion on my shoulders, and i took great pleasure in shoving an 18 gauge into his wrist.
i hadn't mentioned the fact that IV number one was in an artery, yet, and when i did cray cray's tune quickly changed. now all the sudden i'm fired, and he's gearing up to throw the OT shoehorn at my head.
an hour later, i'm "almost back on the christmas list" (oh thank GOD!!!). because he was NPO for a test, he wanted 2 dinners. whatever, if shoving his face with 2 dinners meant he wouldn't be talking to me, i was all for it. but he wouldn't be able to order 2 meals without my assistance, and thus i was presented with THE LIST.
the following is what my patient requested for dinner:
cheeseburger
5 slices bacon
sauteed mushrooms
2 miracle whips
2 salt/peppa
2 slices cheddar cheese
1 slice mozarella
pizza
double cheese/cheddar
ham/pepperoni/sausage
taco salad in a baked shell
lettuce
cheddar cheese
hot sauce
ranch
taco sauce
pepsi and crystal lite lemonade, on ice.
yes. because i spent four years in nursing school to be a glorified waitress.
and after i wasted ten of my precious minutes on hold with dietary and then reciting this ridiculous food order, the patient called down to the kitchen and attempted to order himself ANOTHER food tray, which unfortunately for him cancelled out my order. i'd like to think of that as karma, and it would have been wildly entertaining had my patient not pitched a toddler-esque tantrum over the fact that he was only getting a steak and a chicken leg.
but still i pressed on!! until the unthinkable happened: the patient was made NPO.
and it was like the gates of hell itself flew open.
in a fiery blaze of glory, i was fired (for real this time). i celebrated with a victory lap around the nurse's station complete with fist pumping and a rousing slow clap. it was like heaven smiled on me, and after 9 long days of emotional abuse, manipulation, sexual harassment, and general tomfoolery, i was FREE.
my heart goes out to the coworker who takes my place and enters the lair of this beast. he is truly one of the worst patient's i've ever had, and i'm talking like top 3 here.
i shall close with the words of our nurse's assistant, who had the pleasure of being interviewed by the police after straight cray patient accused her of involvement in his shooting:
"if i'd have done this, he wouldn't be in the hospital. he'd be in the graveyard".
and after putting up with day upon day of his crap, i can agree.
Tuesday, August 21, 2012
what's below rock bottom?
she rolled her car four times before she got ejected from it. she was ridiculously drunk, which is probably the only reason that every bone in her body wasn't broken. she had a lot to drink away. a lost job, an estranged child, a divorce...things that would make a person crazy one at a time were stacked one on top of the other until they became unbearable. and if that wasn't enough, now she has the consequences of her actions to deal with. now there is no car, and now she has a DUI, and now she is broken and without insurance to pay for her hospital bills. but it gets worse, still. on CT, they saw a mass. identified as "cancer until proven otherwise", the 'otherwise' seeming unlikely as there are also spots on the liver.
can life really be this cruel?
they haven't told her about the mass yet...she needs to sober up for that one. and her sister came up to me in the hall in tears. "she's hit rock bottom", is what she said to me. she doesn't know that there's lower yet to go, that things can indeed actually get worse.
and there is nothing to say. no silver lining tonight. it's not fair.
it's just not fair.
Sunday, August 19, 2012
be careful what you wish for
so i'm sitting at the nurse's station talking to a doctor on the phone about trying to discharge the 80 pound 84 year old woman who is demanding high dose percocet before she goes home. her discharge is a hot mess, the caretaker has dementia almost as bad as the patient, and i am fully intending to send them home with a hospital oxygen tank "on accident" as hers is empty and that's sure as hell not keeping her here.
"YOUR PATIENT IS HAVING A SEIZURE!!"
oh good. i promptly hang up on the doctor and run to the room of my patient who i had seen just a half hour before. i had checked on the blood she was getting, started the saline to flush the rest of the unit through, then went on my way. when i left, she was sitting at the side of the bed eating a sandwich.
was. because now she's completely unresponsive with shallow respirations and no attempt to protect her airway. we call a code, the code team shows up and then we do all the code things... labs, ABGs, hook up the monitors, and try to figure out what on earth just happened to this woman who was fine a few minutes ago.
encouragingly, vitals are pretty stable. she's breathing...not particularly well, but could be worse. but she's still unresponsive even to pain, still isn't protecting her airway and we've decided to intubate, so now we're just hanging around waiting for anesthesia to show up with the RSI meds. they come, draw a few things up, and they push the meds.
this is terrifying, because now this patient HAS to get intubated because we have just chemically paralyzed her and i've never seen them do this to someone this alive and i am inches away from the ICU resident who is now using a tongue blade and visualizing the cords, and i feel a little sentimental because this is what i always thought nursing would be and what i imagined i would be participating in on a daily basis and the few other times i've witnessed this i have been pounding on someone's chest and frankly wasn't paying much attention.
and oh, it's just so...COOL. i feel like a nerd for saying that. but it is. and once the ET tube is in, we start bagging and i get to steer the bed up to the ICU and i get to squeeze the ambu bag some when the respiratory therapist can't reach it and it feels very important.
but it's also kind of scary, and i keep wondering if i had missed something big that made this happen, and then my mind wanders to my hot mess discharge waiting to be done, all my other patients, nurse-less, on the floor while i'm up in the ICU and all the documentation i'll have to do on this code.
and then i think back to a couple days before, when i saw this team of nurses taking a patient up to the ICU and how jealous i was of them and how i wished that my job was more gratifying and dramatic and exciting.
be careful what you wish for 'cause you just might get it, indeed.
"YOUR PATIENT IS HAVING A SEIZURE!!"
oh good. i promptly hang up on the doctor and run to the room of my patient who i had seen just a half hour before. i had checked on the blood she was getting, started the saline to flush the rest of the unit through, then went on my way. when i left, she was sitting at the side of the bed eating a sandwich.
was. because now she's completely unresponsive with shallow respirations and no attempt to protect her airway. we call a code, the code team shows up and then we do all the code things... labs, ABGs, hook up the monitors, and try to figure out what on earth just happened to this woman who was fine a few minutes ago.
encouragingly, vitals are pretty stable. she's breathing...not particularly well, but could be worse. but she's still unresponsive even to pain, still isn't protecting her airway and we've decided to intubate, so now we're just hanging around waiting for anesthesia to show up with the RSI meds. they come, draw a few things up, and they push the meds.
this is terrifying, because now this patient HAS to get intubated because we have just chemically paralyzed her and i've never seen them do this to someone this alive and i am inches away from the ICU resident who is now using a tongue blade and visualizing the cords, and i feel a little sentimental because this is what i always thought nursing would be and what i imagined i would be participating in on a daily basis and the few other times i've witnessed this i have been pounding on someone's chest and frankly wasn't paying much attention.
and oh, it's just so...COOL. i feel like a nerd for saying that. but it is. and once the ET tube is in, we start bagging and i get to steer the bed up to the ICU and i get to squeeze the ambu bag some when the respiratory therapist can't reach it and it feels very important.
but it's also kind of scary, and i keep wondering if i had missed something big that made this happen, and then my mind wanders to my hot mess discharge waiting to be done, all my other patients, nurse-less, on the floor while i'm up in the ICU and all the documentation i'll have to do on this code.
and then i think back to a couple days before, when i saw this team of nurses taking a patient up to the ICU and how jealous i was of them and how i wished that my job was more gratifying and dramatic and exciting.
be careful what you wish for 'cause you just might get it, indeed.
Monday, August 13, 2012
i've been writing this note in my head all day
do you know what's annoying? tact and decorum. this is the note i wish i could have written about tonight's most hellish patient:
Thursday, August 9, 2012
trauma tries to kill people, chapter 946
yet again, the trauma team demonstrates that its incompetence and lack of adherence to basic medical principles is alive and well. and yet again, we have a patient that needs to be transfused who will be sitting on the floor, bloodless and half dead, until he is deemed "sick enough" for further intervention.
the patient is bleeding from multiple fasciotomy sites on his leg. his H&H is 6.6 and 19, which is critical. he's tachy at 140. and we're just going to "watch him".
you had better believe that if the intern told me this, i would have laughed in her face and went over her head. but this is worse...oh much worse...as the decision to wait to transfuse until the patient becomes "symptomatic" came straight from the top. allow me to list the problems i have with this.
1. look alive, people, tachycardia is a symptom!! 140 is bad, and if you think we're going to wait until he's taching along in the 160s to do anything about this, you're crazy. i have no problem with calling a rapid response and getting a medicine doctor to give me what you won't.
2. this patient is going to the OR in the am for an orthopedic procedure, which will undoubtably require blood. so what exactly is the issue here? i understand that we don't want to throw a few units into everyone, but this patient NEEDS BLOOD. he needs it now. and if we wait until tomorrow, he will STILL NEED BLOOD, and we will be pissing off ortho and anesthesia by presenting them with a pale, ghostly, corpse-patient to operate on.
3. this brilliant course of action (or lack thereof) was decided upon by the chief resident and attending, both of whom presumably went to medical school and are not stupid. more than one person thought this was a good idea? i have 2 more names for my list of people who are not to touch me should i be hospitalized.
this is where i'm going to get all clairvoyant:
tonight, this patient's tachycardia will progress to the point of instability. he will become symptomatic, but this time with the "right symptoms" for transfusion, aka shortness of breath and chest pain. he will be transfused with 2 units only when he is about to code, or as soon as he feels like he is dying, whichever comes first. and then he will proceed to his surgery where he will receive an additional 4ish units, for a total of 6...maybe even 8.
and everyone will continue to ignore the fact that the trauma surgery team makes poor, irresponsible choices until the next time that they try to accidentally kill someone.
***update***
the patient ended up getting 4 units of blood in surgery, and was then sent back to the floor with a non-functioning, leaking VAC. so ortho is now dead to me too.
***update***
the patient ended up getting 4 units of blood in surgery, and was then sent back to the floor with a non-functioning, leaking VAC. so ortho is now dead to me too.
Sunday, August 5, 2012
things that matter
i wrote this awhile ago and somehow it didn't seem to quite capture the magnitude of what i was trying to say. but in the midst of living in a world where you aren't even safe in church, i needed a reminder that some people are still good. so here it is.
i'm so used to dealing with people who are entitled and want whatever they can get for free, that sometimes i forget there are genuinely good people in the world. every so often, someone will do something so unexpectedly selfless that it just takes my breath away.
we have a woman on the floor. she's a daughter, a sister. her family was in a bad car accident, and she was left to make an unthinkable choice. she decided to donate her brother's organs, because she knew that he was gone and they could do some good. she had us all crying in the nurses station over the sheer selflessness of her actions. to be able to have that kind of grace under such horrific circumstances, and to have the courage to stand up under so much loss is unbelievable to me.
and somehow, even though she's suffered a huge loss, the peace that she has is evident. it makes me believe it something bigger than myself. it gives me hope for humanity, which i had pretty much decided was doomed. it humbles me, and it makes me want to be more than i am. it makes me want to tell the people that i love how much i love them, and to never ever take life for granted.
this woman reminded me of the things that matter. she reminded me to be grateful.
i'm so used to dealing with people who are entitled and want whatever they can get for free, that sometimes i forget there are genuinely good people in the world. every so often, someone will do something so unexpectedly selfless that it just takes my breath away.
we have a woman on the floor. she's a daughter, a sister. her family was in a bad car accident, and she was left to make an unthinkable choice. she decided to donate her brother's organs, because she knew that he was gone and they could do some good. she had us all crying in the nurses station over the sheer selflessness of her actions. to be able to have that kind of grace under such horrific circumstances, and to have the courage to stand up under so much loss is unbelievable to me.
and somehow, even though she's suffered a huge loss, the peace that she has is evident. it makes me believe it something bigger than myself. it gives me hope for humanity, which i had pretty much decided was doomed. it humbles me, and it makes me want to be more than i am. it makes me want to tell the people that i love how much i love them, and to never ever take life for granted.
this woman reminded me of the things that matter. she reminded me to be grateful.
Monday, July 30, 2012
my spidey senses are a-tinglin'
lets play a game!! we will call this game 'is this patient appropriate for the floor?' ready? ok!!
30 year old. known source of infection with worsening cellulitis. BP 82/47 after 4 liters of saline. no urine output as of yet.
is this patient appropriate for the floor? the answer is...
NO!! this patient is septic!! this patient needs an ICU bed!! this patient is not quite in florid sepsis at the moment, but that pressure after that much fluid says to me that he is going to be quite soon. and i said as much to the doctor, with little-to-no verbal filter as always. i told him in no uncertain terms: this patient is unit-bound, and septic, and i am willing to bet money. actual money!!
so the night nurse texts this morning with the latest set of vitals.
T:104.8
HR: 145
BP: 80/54
RR: 30
after 7.5 liters of fluids.
is this patient appropriate for the floor? NO!! did this patient go to the ICU? YES!! should doctors listen to nursing instinct? YES!! but i'm not going to say i told you so...
...ok i am. which is rather generous on my part, because i think he should actually be giving me money.
30 year old. known source of infection with worsening cellulitis. BP 82/47 after 4 liters of saline. no urine output as of yet.
is this patient appropriate for the floor? the answer is...
NO!! this patient is septic!! this patient needs an ICU bed!! this patient is not quite in florid sepsis at the moment, but that pressure after that much fluid says to me that he is going to be quite soon. and i said as much to the doctor, with little-to-no verbal filter as always. i told him in no uncertain terms: this patient is unit-bound, and septic, and i am willing to bet money. actual money!!
so the night nurse texts this morning with the latest set of vitals.
T:104.8
HR: 145
BP: 80/54
RR: 30
after 7.5 liters of fluids.
is this patient appropriate for the floor? NO!! did this patient go to the ICU? YES!! should doctors listen to nursing instinct? YES!! but i'm not going to say i told you so...
...ok i am. which is rather generous on my part, because i think he should actually be giving me money.
Saturday, July 28, 2012
attrition
these are the days that wear you down. i can think of nothing particularly good that i did today, not a moment where i felt like i had accomplished anything of value. mainly i just ran myself into the ground. two of my patients didn't have enough urine output. two others had systolic BPs in the 90s. my 81 year old s/p fall wanted some vicodin, which i knew they wouldn't give to her, so i didn't even bother asking. and then of course there was the typical routine of adversity: missing meds from pharmacy, rude medical students, a patient who repeatedly called after discharge, etc. as i finished up all my charting, i listened as the night nurses paged doctors on three of my four patients. and although i never stopped running during my shift, it was as if i had done nothing at all. as i walked out to my car, wondering if i was going to cry before i started drinking or vice versa, i had to move aside for five nurses moving an ICU patient. she was vented with about eight bags of fluids hanging, and the nurses that accompanied her moved with purpose. like they do something worthwhile. and when they put their own needs aside during the shift, and give way more than they have for the sake of someone else, i bet it's worth it. to look at a patient that's more tubes than skin, and to think 'i am keeping this person alive'. and i run around all day for what? cups of ice and pillowcases. and as i sit here, in quiet despair, i can't say that those things are worth feeling like this.
Thursday, July 26, 2012
things i know, but wish i didn't.
sometimes i'm almost able to forget about how hard this job really is. lately i've been efficient, comfortable, in the zone. i do my thing, make it through, go home, and start it all over the next day.
i almost forget that the things i see are not commonly seen. there are horrors that live in my brain that aren't there for everyone.
most day i operate on pure instinct. so when i heard the crash tonight, and then the screaming, i ran towards the chaos and not away. and i found a woman, not much older than i, absolutely hysterical, shattered dinner tray on the floor. she was screaming, the kind of scream that i recognize because i've heard it before. it means someone is dead.
not everybody knows that sound, i guess. i've only heard it once before, when an ICU nurse came to the floor a few years ago to tell a patient that her husband had just died. it was absolutely chilling.
turns out the patient's house had been robbed, everything had been taken. a cousin had walked in during the robbery and had been shot to death. the patient had gotten a phone call telling her the news, and had come undone...flipped her dinner tray, ripped the cord out of the phone, and started stomping and sobbing and screaming.
oh the screaming. like someone had just ripped out her soul. it's a sound that i still can't get out of my head, even as i sit here and try to cover tonight with wine.
there are things that i've seen that i can't unsee. things that i've heard that i can still hear, and that make me sick inside to think about. it makes me long for a life of cubicles and happy hours, makes me want to be a normal 20-something instead of a nurse.
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