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.

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.  

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. 

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.

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:

Patient continues to interrogate RN with every interaction.  Appears to believe he is more capable of handling his care than ortho.  Constantly asking that ace wrap be taken down despite education to the contrary.  Asking repetitive, asinine questions about medications.  Refusing oxycodone as he states it is "making his pain worse".  States that he needs to "dissect" all the medications that he is being given and keeps copious amounts of notes on his notepad with phrases such as "hot water only, cold makes pain worse".  Would like RN to name all medications taken in the last four days with times and milligram amounts so he can write them down.  Continually contradicts self, has no recall of explanations that have just been given to him.  Prone to paranoid rants.  Each medication pass takes 30 minutes, as patient waffles on which medications he plans on refusing.  Accused writer of lying to him about medications, then several minutes later stated that writer was "on his Christmas list", and he plans on giving writer a Luther Vandross CD and a CD case.  Patient called police department earlier in the shift to report nursing assistant for involvement in his shooting.  States that aide's sister was the one who shot him, aide does not have siblings.  Per detective who interviewed patient, he is "a mental case".  Per RN opinion, patient is manic depressive or schizophrenic and requires medications.  Will continue to monitor, and by that mean will continue to pray for imminent discharge.      

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.

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.