the new crack

so here's a question: what happened to all the crackheads?  does no one do crack anymore?  i thought that they were the worst druggie patients ever, with all their chest pain and moaning and whining and going outside to "get air" aka smoke more crack, but i have seen the error of my ways.  the new worst druggie patients make me actually MISS the crackheads.  yeah, that's right.  do you know who the worst druggie patients ever truly are?  the HEROIN PEOPLE.

seriously.  worst ever.

pain control?  you might as well not even try.  nothing comes close, not even chewing the handful of oxy i just gave you so it looks like i at least tried.

life choices?  bad choices.  like drive your car into a cement wall and smash every bone in your face, bad.  like shoot yourself in the back because "no one cares about my chronic back pain", bad.

had you not been high on heroin, sir, you may have rethought the whole 'a GSW to the back will force them to do surgery to help my pain' thing, seeing as how your back is *still* non-op, only now you have trauma to L4, a massive muscle hematoma, and bullet fragments that snuck into your vena cava circulating through your body.

also you are currently chaptered, so threatening to leave AMA if you don't get more Dilaudid is not the bargaining chip you think it is.

side note: this patient also happened to have five cell phones.  FIVE.  in the bed with him.  so while i already knew he is a heroin addict, now i am also inclined to believe that he is also a dealer.  or he has a lot of friends....who he sells drugs to.  ok.    

STOP DOING HEROIN.  STOP STOP STOP STOP STOP.

so apparently heroin is the new crack.  and all i have to say is bring back the crackheads.  at least i could deal with that kind of crazy.  

bright ideas, part 2.

so it shouldn't come as any surprise that you can't just leave a bunch of free air in someone's chest and try to pretend that it's not there.  because free air smushes your heart and when your heart can't pump right your blood pressure is low and then you can't perfuse your organs and the boluses that you get just makes things worse because your heart STILL can't pump right and when you finally get an EKG done, it reads ***ACUTE MI***.

cue the shock!!

fortunately, this man was not having a 'true' heart attack, and this was nothing that a chest tube and a trip to the ICU couldn't fix.

now, didn't someone suggest a chest tube and a trip to the ICU circa two days ago?

well fancy that.

bright ideas

hey, i've got a great idea!!  lets take this guy with pneumomediastinum, pnuemopericardium, and a moderately sized pneumothorax (aka a bunch of air free in his chest...NBD), do absolutely nothing for him in the ED, and then admit him to the floor!!  oh, he also has a spleen lac and 6 rib fractures...even better!!  he drinks 3 beers and a pint of vodka a day?  perfect.  just perfect.  sounds like someone we should "just watch for awhile" on the floor.  yeah, lets give him to a floor nurse who has four other patients and pray that he can call her before he suffocates to death.

great plan, guys.  lets see how that works out for us.  

guess who's baaaaaaack...

this guy!!  the one with the worst abdominal infection i've ever seen who went back to the OR emergently three nights in a row.  the guy that they told me would die like every time i worked, but who never did.  the guy who drank contrast for a CT and i watched it pour out of the wound on his back.

he was mine for three full months.  i nurtured him, cried for him, fought for him.  i melted hard candy in his ice chips so his mouth swab would have flavors.  we had elaborate rituals where i would spoil him and make the other nurses hate me for it.  our goodbye photo from his day of discharge is apparently still on his refrigerator at home.

he was SO SICK, maybe the sickest patient that i've ever had who's still alive.  his belly was a tangle of enterotomies, his GI tract went nowhere.  he required a full 6 months of TPN with no food by mouth at all, and miraculously didn't get a fatal line infection.  he was a miracle.

and now he's back, fat and happy and pretty close to normal.  he's got gallstone pancreatitis, but compared to what he's been through, this is nothing.  NOTHING.

he is proof that what we do everyday matters.  that throwing ourselves into our work and giving our patients everything that we have (and sometimes more than we have) can change lives.  can SAVE lives.

this is why i wanted to be a nurse.  this is what i naively thought that i would get to do every day.  but i'm realizing that even if i only make this kind of an impact on someone's life every so often, it's worth it.  and successes like this one can carry me through the rest of the days when i feel like i'm not making much of a difference at all.    

diabetes: you're doing it wrong.

so this patient was a long time diabetic who got transferred from ICU after being found face down in the cold unresponsive earlier that morning.  the guy apparently took his am insulin, and never got around to eating any food with it.  why?  because he "musta got busy doing somethin".  something like what, you ask?  

"oh i don't know, maybe i was playin with my cat or somethin".  

yes.  yes, playing with your cat is a great reason for a hypoglycemic coma.  

i was laughing so hard i had to leave the room.  

seriously, now.  you've been diabetic for near EVER, you know that kitty play time needs to wait until after you eat your breakfast.  do better.  

bunnies, not the cute kind.

STOP HAVING SEX IN THE HOSPITAL.

you are post-op day 0 (zero!!!) with a chest tube in and are smelly/bloody/gross/totally unattractive right now and you two seriously have to do it in the recliner chair?  

JUST STOP.

fav quote from the surgical resident "well maybe that will help his blood pressure".

gak.

that is all.


***oh, and i forget to mention that this individual was so hypotensive and sick when he came in (approximately 10 hours before he and his "friend" felt the need to get it on) that he received 9 units of blood, 3 of FFP, and 3 liters of fluid.  guess someone is feeling better now. ***

surge.

these are dark times, my friends.  all of the area hospitals are bursting at the seams, beds are nonexistent, and we are having a thing called "surge capacity" that means that we have to clear out physician and nurse work rooms and stick patients in them.

it's a pandemic!!  it's an epidemic!!

it's a bunch of people with acute-on-chronic lung problems who were too lazy (or something) to get their flu shots.

it is scary, though.  the whole hospital is short staffed.  we're admitting patients to PACU, day surgery, and random makeshift rooms throughout the hospital.  there are no ICU beds, so you'd better pray that your patients don't get sick.  no one can transfer off the floor to anywhere else, so we're doing a bunch of random things like managing patients who need continuous EEG monitoring and other crap we know nothing about.

we're getting by on a wing and a prayer.

also with lots and lots of caffeine.

so if people could actually get vaccinated next year so we don't have to do this again, that would be great.  thank you in advance for your cooperation.

now i'm going to excuse myself so i can sleep for a few hours before i have to go back to work and run myself into the ground some more.

go team!!

nursing resolutions

DO EVERYTHING BETTER, the end.  just kidding.

without further ado, my nursing resolutions for 2013 are as follows:

• be more patient and more kind.  I have a problem remembering that this yahoo patient in the bed giving me the runaround is not actually the same exact patient who said the same exact things last week until he finally gave in, did i what i said, got better and went home.  thus, i need to be patient and kind.  
• care less about what other people think.  is my patient getting the best care?  am i doing what's right for them?  can i sleep like a baby when i go home at night?  these are the things that matter.
• my patients are mine, everyone else can handle themselves until they ask my opinion.  see here.  enough said.  
• advocate first, make friends later.  as much as i would love everyone to like me best (see bullet point 2), i'm going to butt heads with people, and usually people wearing long white coats.  if they think that i'm annoying, so be it. 
• take time to learn something new.  
• make time for the little things, they're what people remember and what make me feel like i'm making a difference.
• put up with less nonsense.  i am a nurse, not a doormat, punching bag, or waitress who doesn't make tips.  

2013, i hold out high hopes for you.  do not disappoint me.