role reversal

so i'm going out with a friend and we call a cab (safety first, right?).  the cab pulls up, the door opens, and i am face to face with the cab driver.  a former patient.  

ack.  

this patient has some very identifying features and i am POSITIVE that it's him.

perfed appy.  needed a drain.  liked popsicles.  had an odd roommate.  all sorts of random facts about him are running through my head, including the embarrassing call that i made to our central supply requesting an awkward medical device that he needed that i will be unable to discuss further due to the fact that the memory still traumatizes me.  

he doesn't seem to recognize me, which is good, because i'm staring at the little cab screen in front of him that is telling him my full name, address, and phone number.  the thought of any of my patients having all that personal information about me makes me slightly gaggy.  but what a double standard, you say!!  i know all about him and his medical info...which is undoubtably more personal than my address.  don't care, still creeps me out.  

so we're driving along, and i'm getting more and more anxious about this encounter.  is he going to say something?  i am DYING to say something, but my friend is in the cab and i think it would be inappropriate.  so i suffer in silence for twelve dollars and seventy five cents.

that was the first time that i ever saw a patient out in the real world, and it was very strange.  

shortage

at the risk of sounding like a paranoid schizophrenic, the world is ending, people.  and this is how we're all going to go.

every day i go to work is a day that i find out that we're short another drug.  first they took our IV zofran away.  this is after most of the other anti-emetics were already in shortage (goodbye droperidol, i miss you compazine). hey, do you know who gets all barfy?  surgical patients.  trauma patients.  ALL MY PATIENTS.  but that's ok, stick this tablet under your tongue and try not to actually vomit until it dissolves.

then they took my IV metoprolol.  hello unsafe swallow dementia patient who is 81 years old and has the A-fib.  allow me to chop this pill up and swirl it in applesauce, then say a prayer to the hospital gods that you don't 1. aspirate in front of my face 2. spit it back at me or 3. refuse to swallow the yummy mixture until i have to go in after it with the yankaur.

IV benadryl?  don't need that.  when the anaphylaxis sets in and my patient is unable to swallow a pill due to her rapidly expanding tongue, i'm sure that pharmacy will be able to sent me a vial from the medicine vault before she codes.  

and who really thought that IV ativan could be adequately substituted with PO?  i would like them to come try to hold down the CIWA patient who's in full DTs while i try to shove a pill down his throat.  

but the worst of all came last week, the shortage that has truly made me think that the apocalypse is upon us.  

OUR PCA SYRINGES ARE IN SHORTAGE.  cue widespread panic and looting and pillaging and angry mob-bage.  

summer is coming, and my unit becomes land of the PCA.  so you got shot 8 times while "just sitting" in the car outside your house eating yourself some chicken?  please have a PCA!!  oh, you got stupid drunk and then hopped (helmet-less, of course) onto your motorcycle and ran yourself into a wall?  enjoy delivering your own medication, via PCA, for your comfort.  

all sarcasm aside, the shortages really are starting to scare me.  sometimes a PCA is the only way to get pain under control on the floor.  with 4-5 patients, i don't have the time to sit in one patient's room pushing small doses of narcs every 10 minutes, nor to i have the monitoring capabilities to give high-dose narcotics.  therefore, summer will go one of two ways.

1. you will get your 2-4 mg of IV morphine or 0.2-0.4 mg of IV dilaudid q 1 hour PRN and like it.  i will make you ice packs and heating pads and prop up your broken limbs and fluff pillows and emotionally support you until you are vilified.  and everyone will be pain-free and happy. (likelihood: haha, yeah right)

2. first the MDs will try to make the nurses human PCAs and write for PCA dosing to be giving IV push.  after that gets shot down, they will begin to write for larger doses of meds and i'll be back to the days of keeping an extra vial of narcan handy.  then narcan will go into shortage and the world as we know it will really be over.

makes me want to go all doomsday preppers and start hoarding dog antibiotics to prepare for end-times, i tell ya.  

ode to trauma

why, oh trauma, must you make my life so hard?
the patient comes up bleeding, big circle on the pillow
why did you not find the lac in the ED?
fix her there, and i will not have to give my firstborn for a skin stapler.
nor run to the OR myself to fetch it for you.
and why, oh trauma, do you ask me to wash her hair?
it is monday, it is the start of my shift, this is my 5th patient.
i have not seen the others, and i don't know if they are all alive.
while you're at it, trauma, please address this patient's gaping ankle wound.
you need more supplies? but of course.
i will sell my body to the OR in exchange for some 4.0 nylon and a needle driver.
and also, trauma, where have you hidden her orders?
they do not come up with the chart.
they are not at the desk.
oh!!  they are in your pocket.
"that does me no good"
that may have been hostile, but it is the truth.
lastly, dear trauma, would you please give me ointment?
this patient is covered in scratches
bacitracin? neosporin? triple antibiotic?
"whatever you want.  you decide"
now THAT is the best thing you've said all day.

DDS

we must be getting desperate for residents to fill the trauma team month after month, because it's april and we've got us a DDS.

really?  sir, you are a dentist.  what are you doing here?  i have the utmost respect for your profession, and see my dentist on the regular (shout out to dr. p!!), but why?  just why?

i assume this is because you want some oral surgery experience?  perhaps you should have been placed on the oral surgery team then, hmm?  i mean really, can i even take orders from you?  i spend many a day wondering if the residents i come in contact with did indeed graduate from medical school.  you did not even GO to medical school.

it's no wonder that you wrote that order for fluids to be D5.45 half normal saline with 60 mEq of K+.  first of all, the .45 is the half normal saline, and secondly giving 60 of K bolus is something akin to lethal injection, or at the very least a very bad idea.

i'm sure you're going to be a very nice dentist, because you have pretty eyes to look into and you're personable enough to chat with, but you have no business managing trauma patients.  i am, in fact, scared of you and your cohorts, seeing as how this month we got some of "not the brightest crayons in the box" so to speak.  between you and your pal who likes to try to kill dialysis patients, its been a long few weeks.

seriously, is it may yet?

things patients say

RN: "so, what happened to you?"

Patient who has been shot on 4 separate occasions: "guess I didn't run fast enough."

no.  no, you did not.

ick.

two words: uterine prolapse

and me, manually reducing it x2 my shift.  

if you know what this means, please commence feeling sorry for me.  if you don't...well, consider yourself lucky.  

goodnight.

bad idea

so we have a morbidly obese dialysis patient with a broken arm who all the sudden can't breathe. of course, the first thought from our merry band of doctor friends after she's maxed out on 02 on 15 liters via nonrebreather mask is Bipap!! Oh yes, we can put her on Bipap and pretend that there's not a problem. which we do, for several hours. then someone comes up with the idea of a chest CT, which is no doubt going to find the massive PE we're all praying she is not going to throw right here, right now. problem with that being that girlfriend only has a foot IV. it is at this moment that someone from the trauma team is smacking themselves upside the head wishing they would have listened to nursing the day before when we suggested a central line. oh well, no time like the present to dig around in a dialysis patient's chest, right?

so the patient looks bad. her sats are fine on bipap, but her ABGs are crap. in preparation for CT, we're pumping her full of bicarb through that trusty foot IV. unfortunately, dialysis patients aren't exactly amenable to IV fluids at 300cc/hr, so her BP is now 220/114. at some point in this disaster, someone finally comes to their senses and gets an ICU bed. so the smart thing to do would be to go to the ICU, get a central line, and then have the ICU RN go with the patient to her CT in case she codes in the scanner.

so naturally, that's exactly the opposite of what we're going to do.

the resident would like to place an EJ at bedside. and he would like me to put the patient into trendelenburg to do it. so lets recap: morbidly obese. on the bipap, and can't breathe that great sitting straight up. already with sky-high pressures. and you think we're going to tip her upside-down on her head?

the day nurse and i just looked at each other. "get the code cart", she says to me.

so yeah...nooooo...we didn't do that. and then the patient went to the ICU and got a central line done all proper-like.

you're welcome, baby doc, for helping you not accidentally kill your patient with your ignorance and bad ideas. and next time, when i politely try to tell you that something you're doing is stupid, why don't you go ahead and listen to me and save the roll-y eyes for when you're back in the cuddly bosom of your MD pals.

k thanks.

loss.

it would figure that one of my favorite patients would die of something completely unrelated to what we treated him for over the course of 3 months last summer.

that the sweet man who called to say thank you to his nurses on christmas would pass a few short months later.

he was one of the most genuine patients that i ever met. you couldn't help but love him, even when he was annoying your or grossing you out. he cared about me too, i could tell. not in the 'you hold the key to the narcotics' kind of way, but actually saw me as a person, not just a juice dispensing, blanket-fetching, pill passer.

we put him through months of hell to fix him: surgeries almost every other day, skin grafts, bedside dressing changes that were so painful to him that they left me in tears, refusing to do that EVER again. after the months of inpatient hell came the rehab...more months of relearning to walk. he would call with updates, or pop down to the floor to keep us posted on how he was doing.

he was living, breathing, walking proof that this thankless sad job actually means something once and awhile.

and then today, he wasn't. he died in his sleep from something probably totally unrelated to all of his other issues.

it's cruel, really.

and it hurts. like i can see why people walk away from nursing, hurts.

i invest myself in my patients, not because i'm flo nightingale, but because i can't help it. i care about what happens to them, especially the ones that i get to know over the course of weeks and months. i've never lost one of "mine" before. i don't like the way it feels.

i hope i made an impact on his life like he did on mine.