and it always starts with someone naked and bleeding.

it started when i went to answer the call of my people, aka the bed alarm.  i was two steps behind another nurse, and we were equally surprised to find...well basically this:

but naked and bleeding from the chest tube that he had just pulled out.

so now sucking chest wounds equal panic time, so i grabbed gauze and my coworker tried to get the patient to sit back down.  we tried to get an occlusive dressing over the site and meanwhile he's swinging at us, screaming obscenities.  we wrestled him back into bed and it took four of us to get him in restraints, as i'm frantically paging for a monitor, security, the stat team, the doctor and everyone else you can think of.  so the guy looks creepy at baseline, but now he's breathing at 30+ breaths a minute and i'm getting scared that he's ready to go out.  so on went the O2 facemask, which only spun the patient up more.  so picture this little terrifying man, still naked, covered in old blood, cursing through his facemask and trying to claw and bite it off his face.

this is what i call a typical saturday night, sadly.

haldol is my friend, yes it is.  after 5mg IV he was more like this:

i can work with this.  believe it or not, the chest xray looked decent, so he bought himself a night with no "motherf*ing hose shoved in me you sons of bitches!!"  

and also a sitter and four point restraints, so there's that.

happy sunday!!  hallelujah.  

 

new favorite

so my patient has 2 wives, one real and legal wife, and one "wife" who showed up at the hospital with her lawyer in tow calling herself by his last name.  the whole situation is a cluster...the patient is a brain injury and no one wants to claim responsibility for him.  the only one who visits him is his AA sponsor, which is especially generous of him considering that the patient got hit by a car while wandering out into traffic drunk and high.  so our social worker goes into the room to get the low down from the sponsor about the wives situation.  turns out that the "wife" with the "same last name" and the lawyer is actually a "crack whore tryin to see if he got money".

i'll give you a dollar if you can guess what the social worker wrote in the chart.

that's right.  word for word.

so now the "wife" is an officially documented crack whore tryin to see if he got money.

i swear, sometimes i love this job.

no good deed...

"room 28's wife says her water just broke.  what do i do?".

our newest nurse looked nervous as she grabbed me out of the hallway.  i went down to the room and talked to the wife.  sure enough, she was 37+ weeks pregnant and was leaking fluid out onto the floor.  i called the ED, who told me to call L&D.  i talked to the charge nurse up there and told her to expect the patient and her s/p motorcycle crash husband with his chest tube in tow.

apparently this is where everyone started freaking out.

first my assistant manager says that we can't go to L&D, we have to go to the ED "because of EMTALA".  seriously.  there is a law about that?  ridiculous.

then transport freaks out because the chest tube is to portable suction.  mmmkay...not like you take people with chest tubes on suction to tests EVERY SINGLE DAY or anything...

so the wheelchair caravan of terrified first time parents/trauma patients and spouses heads off to the ED...where they are immediately sent up to L&D (um, told you so.  ok).  the nurse settles her patient in and reminds him that L&D can't give him meds or any cares, and gives him all of our numbers to call when he needs anything.  she comes back to the floor to update the trauma team

...which is where everyone resumes freaking out.

the intern apparently asks "did you get permission for that", which is where i will begin side rant.  permission...seriously.  this from the service that acts like any nursing request is inconvenient to them.  the service that will let patients get as sick as humanly possible before intervening just to 'make sure' or something like that.  the service that has been in the ED with traumas for the past 4 hours and has made it clear a million times before that floor priorities are NOT priorities.  you wanted us to ask PERMISSION for the STABLE patient to go WITHIN THE HOSPITAL with his very pregnant and terrified wife to help her give birth to their baby.  mmm.

i'm still not understanding why everyone is so riled up, but i feel responsible because the nurse asked me what to do and this is what i came up with.  so when i saw the attending come to the floor, i excused myself from my patient's room and went to see what was up.

"WHERE IS ROOM 28!?!?"

 i haven't really seen this attending raise his voice before, and i am about to pee my pants in the nurses station because i'm the one who did this.

new nurse (bless her) stood her ground and replied simply "L&D bed 12".

"WHY IS HE THERE?!?!"

i couldn't take it anymore "this whole thing is my fault..." and i explained that i had done this before with another patient several years ago.  that the patient can come back to the floor for assessments and whenever he's needed by the doctors.  that the L&D nurses are not responsible for him and that we need to provide all his meds and cares.

the attending relaxed.  "oh, that's reasonable.  we had been told that he had a bed on L&D".

they seriously thought that we transferred the patient to L&D.  

after we all finished laughing hysterically, i was a little offended.

so the nurse went over to L&D to give the patient his night meds, and who was there but the attending. telling the patient that he should come back to the floor.

I.  GIVE.  UP.

you ask those people things, and they act like you're the biggest inconvenience in the world.  you try to be autonomous and make reasonable decisions for yourself and this is what comes of it.  NOW they care, when every other thing that you bring up gets you an eye roll.  NOW they want to be involved, when they were previously very busy in the ED and not to be disturbed.  NOTHING that we do is right, EVER, and i'm over it.

i tried to help a couple have a decent birth experience, and all that i got out of it was a headache and the knowledge that the trauma team thinks that its nurses are stupid enough to transfer one of their patients to L&D.

so it's true.  no good deed goes unpunished.

year five.

five years.  five years.  five years.

what have i done with the past five years?

what have i done with the past one year?

i guess that's a little easier.  2012 was a blur of worry and stress, so for the last 6 months of it, i did exactly nothing.  and i needed that.  the beginning of this year started out pretty rocky.  i finally cracked under the pressure of trying to do too much, and i took a step back from all of the 'extras'.  i've been trying to get ahold of my emotions and facing the fact that i'm old enough to have to act professionally, whether i like it or not.  thus i've been trying to express my feelings and my job concerns constructively, through carefully written emails and well placed, fully thought out comments.  as someone who enjoys saying outloud the first inappropriately direct thing that comes to her head, this has been difficult.  but when you start to wonder if you are becoming enough of a troublemaker to be fired, it's time to shut your mouth.

the phrase "it is what it is" is an unofficial floor motto, and i kind of hate that.  but for the first time, i actually understand why people feel that way.  there are things that i would have dug my heels in and fought over three years ago that i've just given up on these days.  i just don't have enough energy to get worked up over every injustice like i used to.  does that make me bitter and washed up?  i hope not.  i can still work up some passion over the big stuff.  i guess i'm just trying to let the smaller things roll off my back...finally learning to accept that there are a whole lot of things with management and new policies that i'll just have to deal with.

i don't think that i'll be on the floor too much longer, to be honest.  i'm tired of being constantly running and feeling like none of my patients are getting as much care as they deserve.  i think that my personality is better suited to someplace like the ICU, where i could focus my energy on taking really good care of a few people.  i'm ready for new challenges.  i'm ready to do crazy things.  i'm ready to save lives, and not just heat up people's dinners and bring their family members extra blankets.

five years on the floor has taught me A LOT.  but five years on the floor might be enough for me.

whatever happens, i'm not who i was five years ago.  i always joke and say that i used to be a nice person before i became a trauma nurse, that the floor ruined me.  sometimes i worry that it's true.  but overall i think that i've changed for the better.  i might not be as nice, but i'm not a pushover.  i might feel like the weight of the floor falls on my shoulders a lot of the time, but i actually know what i'm doing.  i might have people who are sick, but i'm confident in my ability to get them what they need.

i started out five years ago, straight out of school and terrified.  i didn't know how i was going to make it from week to week in the beginning, and i'm sure that people thought that a basket case like me wasn't going to make it very long on the floor.  and here we are.  five years later.

the job probably didn't get any easier, i just got better.

i've officially survived five years as a nurse.

thank god.