'trauma season'

opportunities for blogging have been few and far between this summer. partly because i'm concerned my words will be used against me, partly because nothing seems strange to me anymore and partly because i've been exhausted. summer is notorious for being crazy. it's the time of year when people fly into rages because they're so hot, drink too much, and ride various wheeled things without helmets. summer is always full of trachs, chest tubes, and (my fave...NOT) road rash. so here's the summer in a nutshell:

19 year old gentlman with a GSW. he's a familiar face because he also got shot last year and was on the unit. he goes off for surgery one day, and his fiance and baby mama take the opportunity to throw down. the day RN kicked them off of the floor, so they continued their business at the bus stop. as a result, the fiance was banned from the hospital for 24 hours and the baby mama got her car towed and can't ever come back. i spent the rest of that shift on the look out for the offenders. unfortunately the only physical description i had were "has fake eyelashes" and "wears really short shorts". this does not really narrow things down.

40 something with some mental health issues...tried to commit suicide in several ways and didn't. she got up to go to the bathroom and suddenly became all grey and catatonic. we got her back to bed and she still wouldn't respond to us. we paged our MDs 3 times without success, so i stalked them in the trauma bay (as i learned was expected of us here. i got a less than helpful nurse who informed me that there was a trauma alert (ask me if i care. do i care? NO.) and hung up. she called back 2 minutes later to pass on a message from the trauma team: call a code and call the ICU resident. well lets all step back a minute here and think about this. did i say the patient wasn't breathing? that she was pulseless? and really people, if the patient were coding do you think i would walk away and ask the doctors what i should do about it? girl, please. so anyways, i didn't call a code, the ICU resident came down, and the patient was whisked away to the CT scanner. the trauma team never came up to see her. the intern, however, did call back after everything was done to drop a few F-bombs and criticize our management of the situation. so there's that.

my summer project: a middle aged diabetic with necrotizing faciitis...basically flesh eating bacteria. because he didn't manage his blood sugars, the bacteria tore through his left leg and groin. the doctors went in and removed the dead tissue down to muscle and vessels. he's been on the floor for 2 months with surgery after surgery to try to repair his leg. now i'll admit, at first i wasn't a fan. he was constantly on the call light and i never got to him fast enough for his liking. he was always farting and burping, peeing on open wounds or calling for the bedpan. he liked discussing his bodily functions in exquisite detail and scratching his man-parts. i won't lie, he utterly repulsed me. but after a while, i got to see the person underneath all the grossness. and as i took care of him more, i found an average guy who just wanted to live a normal life. he uses walkie-talkies at walmart to talk to his girlfriend. he sells vintage lightbulbs on Ebay. he knows how to fix cars. inside he's a gentle man who just wants to go home to his girlfriend, their cats, and his simple life. i won't lie, sentimental fool that i am it breaks my heart just a little. and it's always a good reminder for me: people are just people.

so trauma season is drawing to a close...i'm a little sad because it's my favorite time of year, and i creepily enjoy picking gravel out of people. oh well, there's always next year.

confessions.

these things happen from time to time. the nights where i can't seem to complete a task. when nothing goes right, when i'm off my game and i leave work feeling completely and utterly defeated.

geez it is HARD having a type-A personality. i want everything to get done, done right, and done on time. i want everyone to like me. i want my patients to be clean, pretty, and healthy, i want the doctors to love me and trust my judgement. i want to be admired by my peers and respected by everyone around me.

HA.

instead i am constantly frazzled, running around like some sort of schizophrenic person. i mumble to myself as i walk, a combination of things i have to do and prayers to jesus to make the mess of my day better. most nights i feel like i'm neglecting my patients, because i never see them as much as i want to. there is always at least one desperate plea aimed at an aide to "please go see room --- and make sure that they're still alive because i haven't been in there in hours". my coworkers must think i'm absolutely insane, because i go onto tirades about injustice on a daily basis. the doctors want to steer clear of me because they don't want to hear my obsessive theories about what's wrong with their patients. my meds are always late, my charting is never as complete as it should be and yesterday i totally forgot to write out my report sheets AND i didn't do careplans. i almost always punch out at least 45 minutes late, and then i drive home only to remember several things that i forgot to do. my patients are never walked as many times as they need to be, i don't do IS with them every hour and sometimes i don't make them wear their SCDs. and i don't think that any of them ever brush their teeth which i think about all the time but am always too busy to ask. i'm horrible at prioritizing, i really don't know where any of the 'time' in my 'time management' goes, and almost every task takes me at least 3 trips in and out of a patient's room.

but before someone tries to take away my license...

i care about my patients. i give 100% even when that's more than i have to offer. i try to practice with prevention in mind. and i believe that making my patients feel comfortable is more important than giving them their meds on time or doing all of their paperwork.

so tonight, that's going to be enough for me.

i feel your pain

i've been coming face to face with some tough stuff this week. last sunday i learned that a younger guy who i go to church with has a brain tumor. for some reason, this hit me especially hard, even though we're only acquaintances. fortunately, he's had surgery and is doing great. i'll be honest, i was glad that everything was pretty much over so i could get rid of the pit that's been in my stomach ever since i heard about his situation. however tonight i was shocked to learn that ANOTHER guy, someone i was involved with in college, was recently diagnosed with a brain tumor and will be having surgery next week. though we're not close, this also makes me feel sick.

i'm feeling the weight of dealing with this as a nurse as well as a peer. when anyone your age has to face something like this, it's pretty jarring. there's always the "he's so young" and the "it could be any of us" and the worry that comes when you get to thinking about what could be lurking in your body that you have no idea about. but when you're a nurse, it's different. you don't get to ask why or get upset, sick people are your job. you don't get to wonder how this happened or ask questions, people expect you to have all the answers. you're not supposed to get scared, despite the fact that you know waaaaay too much not to be terrified.

people get sick everyday, this i know. well people get into accidents, some of them are irreparably damaged. but when it's "my" people, it's different. when i can say "hey that guy leads singing" or "i kissed him when i was 21" it's real. this is the same feeling i have when i take care of palliative patients. the fact that someone can be here one minute and gone the next continues to boggle my mind. how is it possible that i have to deal with this in my 20s? because surely other people my age have cubicles and are thinking about happy hour, not calling a patient's husband to come to the hospital because i just held his wife's hand while she died.

this is not what i signed up for, yet no one really seems to understand that. the general consensus is "you're a nurse, this is what you do, you should be about to handle anything". therefore i'm not really supposed to get upset about patients because they're only my job. well i can tell you right now, not getting emotional isn't my strong suit. i take things personally. i can't leave work at work, i have never been able to and i don't plan on starting anytime soon. it's part of what makes me a good nurse, but all that empathy really takes its toll. this week i had a patient in pain and i COULD NOT get it under control no matter how hard i tried. i gave her narcotics, i gave her nausea meds, i gave her GI cocktails. i called the doctor and got her meds increased, then i called him back 10 minutes later and got the meds changed altogether. nothing worked. she was crying, rocking back and forth in her bed and there was NOTHING i could do for her.

so i went in the back room and i cried. because watching people suffer and being powerless to change what is happening to them hurts.

so maybe that's why i'm so upset by the brain tumors. because the nurse in me wants to make this better, but both situations are out of my hands. and, in case you can't tell, giving up control is also not my strong suit.

disclaimer, part 2

unfortunately, i've learned the hard way that people will use just about anything against you to prove a point. i've recently had some issues with social media...long story short, i may have accidentally offended some people by talking about work.

actually, that's a lie...i got caught in the crossfire of two grown women acting like teenagers and got put on probation for several very nondescript, non hipaa-violating comments that were discovered during their adolescent fighting.  i never actually violated the social media policy, but was still punished for it.  apparently large, powerful hospitals need scapegoats to keep all the little people in line, and i was lucky enough to get to fill that role.  

for the sake of clarity, i'd like to say a few things.

to state the obvious, the views and opinions expressed here are those of my own and not of my employer (duh). i don't speak for anyone but myself, and surely we all know that i'm just a touch biased with these stories :)

for the record, i work at a very good hospital with very good people. while some of my stories may highlight my frustrations, there are plenty of other fabulous things about work that i don't blog about. overall, i think that my place of employment provides great care, otherwise i (obviously) wouldn't work there. the issues that i have with doctors, patients, and really the hospital environment in general are pretty universal. i may rant and rave like a crazy person on a regular basis, but should i ever be in need of care i wouldn't hesitate to use my employer.

so to sum things up, i am taking a risk by continuing to blog. but even though other people might think i'm crazy, to me it's worth it. there is a type of satisfaction here that i'm not ready to give up. and frankly, i think it's pretty great to look back on the situations i've been it over the past year and see how far i've come.

so i'm going to continue. because if there's one thing that being a nurse has given me, it's a backbone. i spend most of my days advocating for my patients, now it's time for me to fight for myself.

cause we're not having fun until somebody is bleeding out

this week on my list of mortal enemies: the ER. the ER has certain habits that drive me crazy. for example, they frequently send their patients up to the floor naked, usually bleeding, and often with empty IV bags dragging behind them. so today when i got a stab wound to the chest from the ER, i was not surprised to find him pretty much as described above. the MDs had put in a chest tube, and i was taken aback when i saw that it had already put out about half a liter of blood since it was placed. i got the patient settled with another nurse and we pulled off the dressing that was leaking blood everywhere to put a clean one on.

still bleeding.

i called the doctor and told her how much blood was in the cannister...now about 600ccs. she told me to start fluids and she'd come see him. i did his admission.

still bleeding.

850ccs. paged the doctor again. she called back. now 975ccs. she said she'd call her attending and that we'd make him nothing by mouth for possible surgery. at this point the patient began yelling at me that he wanted dinner.

still bleeding.

the blood in the chest tube was now in the second chamber, so over a liter. vitals still ok. patient still yelling "i shouldn't have even come here" because i wouldn't give him his dinner tray. and finally, the bleeding seemed to slow down. 1130ccs. i took some vitals, and he was still ok. he fell asleep, and i let him be.

20 minutes later i'm (miraculously) seeing another patient when the doctor came in. apparently they had seen the patient and taken his blood pressure. 70/42. suddenly there was a sense of urgency. we needed fluids wide open, a type and cross for 4 units of blood and to get the blood right then then give it. all while getting pressure bags for the fluids and getting the patient hooked up to the dash monitor. um, not going to happen. i basically got as far as the fluids before the doctors started to yank the cords out of the wall so we could take the patient to OR. i managed to get one final BP in before that too got disconnected: 65/40. cue panic.

every once in awhile, the hospital really is like tv. and if i've ever felt like i'm on primetime, it was tonight as i ran down the hall towards the OR with a pressure bag in one hand and the other hitting the patient to make sure he was still alive. how we made it to the OR in one piece i will never know, but there i was under the bright shiny intimidating lights. the next thing i knew everyone was gowned and gloved and i was feeling very conspicuous. someone handed me a hat and mask, at which point i made my exit. frankly the OR freaks me out...way too clean and you can't touch anything in there...so that was that.

i honestly expected the patient to come back to the floor, but he got an ICU bed. when i took his belongings up, he was intubated and looked like a hot mess. and to think, 4 hours earlier he was stable enough to come to the floor.

so do i blame the ER for this? not really. they didn't really see the patient bleed all that much. and do i blame the doctor? she was actually pretty on top of things. and do i blame myself? no way, i rocked this one :) i kind of feel like this is just one of those things that happens...hopefully the patient will return to the floor no worse for wear and grateful that we helped him.

but for the records: it wouldn't kill the ER to throw a gown on a patient every once in awhile. sheesh.

patients: hazardous materials? i think yes.

let me begin by saying that i should be making some sort of hazard pay. as a trauma nurse, patients try to beat me to a pulp on a regular basis. I've been scratched across the chest, pinched, had patients try to bite me, been kicked at, had people try to punch me in the face, been screamed at, sworn at, and called every name you can think of and some things you can't including an "f-ing bed whore"...seriously, what does that even mean? tonight was no exception.

it all started when i answered the call light...come to think of it i really should stop doing that. the woman on the other end was frantic. her son was having a seizure. so i gathered the other people in the nurse's station and we ran down to the room to find the patient seizing. we all did what you're supposed to do in a seizure, which is basically nothing. we watched the patient so we'd know what happened during the episode and kept him safe. for this particular patient, that meant putting his helmet on. he had recently had brain surgery and they'd taken out a piece of his skull. this means that he has his brain, then some skin, then the outside world. so on went the helmet, he stopped seizing after a minute or two, and we all thought we were in the clear.

haha.

of course after this seizure, he was confused. he kept grabbing at his oxygen and trying to rip the helmet off his head. his O2 sats weren't great, so i held his hands down so he couldn't get at the tubing. and needless to say, we didn't need the man with the exposed brain to start thrashing around. we kept him calm for a little while, but then he started to fight us. the more we tried to hold him, the harder he pulled away.

so i called for reinforcements.

then there were seven or eight of us trying to hold him down, and it still wasn't working. now he's screaming and thrashing at us. i unfortunately didn't have gloves on and couldn't let go to put on a pair, so he was trying to scratch me. when he still couldn't get free, he started kicking and biting. at this point we're yelling for restraints and i'm frantically calling for more help. we called a rapid response, then security to the floor. it seemed like FOREVER until the oldest security guard we have who must be at least 75 showed up. by this time we had respiratory therapists in the mix and the patient was almost totally restrained, but still clawing at people. it's kind of fuzzy to me when I finally gave up trying to hold him down, but i think it was around the time that i realized i was bleeding.

great. just what i need in my life, another incident report with my name on it.

the casualties included 4 people with claw wounds and 1 very unfortunate nurse with a bitten thumb. we all declined the trip to the ED, but there was free antibiotic ointment for all for our efforts. the patient eventually calmed down, after 4 mg of ativan and all of his extremities tied down.

i would like to take this opportunity to mention that NEVER ONCE IN NURSING SCHOOL DID ANYONE MENTION THAT I WOULD BE ASSAULTED ON A ROUTINE BASIS.

please excuse me while I go put in my transfer to the OB floor.

be forewarned: this is a rant.

"those who can, do. those who can't...apparently run this place"

i have a love hate relationship with our trauma team. mostly hate. as a whole, the team is made up of underachievers. the residents are less concerned about quality patient care and interventions that make sense, and more concerned about guessing which orders their seniors would like them to write. they don't order tests, because they don't want to know what's going on. they hate labs, because then they will be obligated to come up with interventions. they loathe medicine doctors above all else, and frown on nurses who call on them for help in emergencies. i have decided this is because they feel threatened by these doctors because they know about medicine. they have taken nearly everything that i learned in nursing school and thrown it out the window. there are many days that i feel personally victimized by our trauma team, one of those being today.

i have a patient that i'm watching like a hawk. he's here because he stabbed himself. when i got him out of surgery, his heart rate was in the 140s-150s. not ok. the team ran a few tests, and determined that he wasn't having a cardiac issue and that his blood counts were decent. apparently this was good enough for them, so we let the patient sit at this heart rate for 24 hours.

the next day, he became short of breath. they sent him for a chest CT and found out that he had a pulmonary embolism. NOT OK. i have watched people die horrible deaths of PEs in front of my face, and as a result i live in fear of them. it's the kind of condition where a person is talking to you one minute and the next they aren't breathing...completely terrifying and emotionally scarring. so one can imaging how i felt when i found out that the patient had not one but two PEs in the left lung...kind of like i had just been handed a ticking time bomb. i started the patient on a heparin drip to thin his blood, and we kept a close eye on his vital signs.

so imagine my surprise when i come to work today and my patient is off his heparin drip. when i asked the day nurse why, she quoted the trauma team. "his PEs are little...he probably had them before he came in. and he doesn't have insurance". allow me to break down the things that are wrong with this into an itemized list.

1. the PEs are little. ok, so certain types of PEs aren't as serious. but personally, even the thought of little ones make me want to wet my pants.
2. he probably had them before he came in. maybe. although this would fall under another of the trauma team's biggest faults, the failure to acknowledge/treat/give a crap about pre-existing conditions. basically, the doctors will say "this is their baseline" and use that as an excuse not to deal with the problem. once again, not ok. and for the record, the patient's first EKG didn't show changes that would happen due to PE, and the second and third EKGs did. therefore, we might want to rethink this theory, people.
3. he doesn't have insurance. i think i can sum that one up with a OH NO YOU DIDN'T.

fine, so we aren't going to treat his PEs. but he also has chest pain. and blood counts that are half of normal. and suddenly, i understood!!! his body doesn't have enough blood cells to deliver oxygen to the heart. low oxygen equals chest pain. this can also explain his sickly grey death skin and the fact that he just sleeps all day long. it was like heaven opened up and the angels sang. we could give him blood and he would be better!!

so i did what a good nurse is supposed to. i went to the resident and presented my evidence. i had labs to back me up. i had a good argument based on pathophysiological principles. i followed the right steps. and then i got the order, gave him blood, and everything was perfect, the end.

oh wait. actually i was told that "it will be discussed", and then my (right) idea was completely shot down and the team decided to give him some lasix to get rid of extra fluid. apparently the idea de jour is that his blood counts are low because his blood is diluted. DID WE ALL GET OUR MEDICAL LICENSES OUT OF A CRACKERJACK BOX?!?!?!

i am tired of being rejected by the trauma team. i'm tired of working hard to think critically to have no one take me seriously. i'm tired of the groupthink. and i'm tired of caring about these patients and feeling like nobody else does.

but do you know what i'm not tired of? being right. mark my words i WILL give this man blood if it's the last thing i do. because he needs it. it will make him feel better. and it is medically appropriate. and i don't need the trauma team to validate my feelings.

but i will enjoy saying i told you so.

rant over.