run and tell that.

a while ago we had a visit from some governmental friends.  while they who will not be named were in the house, we had an unauthorized dog running around the floor, a patient trying to bathe themselves with cavi wipes, and a patient elope to mcdonalds playland for 3 hours because "nobody told me that i couldn't!!".  cue widespread panic and cover ups to ensure that we didn't look like morons and get dinged 234098234 times for violating like all the policies we have.

and while our visit with 'the man' went fine, it always ticks me off when they're around.  mainly because we have to spend more time worrying about timely charting than about actual patient care.  and because i have to hide my coffee.  but now they're gone...let the use of unauthorized hand lotion begin!!

in which i am traumatized by camp nursing.

so i do this thing every year where i work a 70 hour week and then head straight to kids camp and be their nurse for a few days.  every year i dread it, and every year i leave happy and feeling like i did something good.  for the past few years, i have soothed the hypochondria of children and put on some band aids.  this year, i expected more of the same.

that was, until, the very first night of camp.  when a mere 5 hours after the kids arrived, i heard the horrific screaming that only comes when someone is very very hurt.  my suspicions were confirmed when people started yelling for me, so i followed the noise to the kid writhing in pain on the ground with a very obviously broken arm.

now i'm a trauma nurse.  but i don't work peds, and i'm not a first responder.  the fractures that i see are all splinted or ex-fixed or at the very least, covered in some way by the paramedics.  i'm definitely not used to seeing such a little hand just hanging there, especially when it's attached to a terrified little kid.  i would like to say that i launched into nurse mode, but i actually think that it was more like mom mode.  i grabbed the crying child, pulled him into my lap, and held on for dear life.  the arm was bleeding, and even when i was asking him if he remembered falling on anything, i was pretty sure we were dealing with an open fracture.  and instead of my nice shiny sterile hospital setting with all of my supplies, i'm sitting in dirt at the bottom of a hill with a first aid kit that somehow doesn't have gloves.  and this is my fault, because i was the one who "restocked" the first aid kit....just not very well, apparently.

i honestly think gloves wouldn't have mattered anyway, because the kid wouldn't let me do anything to his arm.  i had nothing to splint it with.  the open area was all the way underneath the arm, where i would have had to twist it to look, and he was having none of that.

so there we sat.  in the dirt.  at the bottom of a huge hill.  him in my lap, his broken and bleeding arm laying on top of my intact one as i acted like a human splint.  i held his hand on the broken side, and we waited.

i have never been so relieved to hear sirens in all my life.  we packed him up in the back of the ambulance and went to the hospital, where the xray showed a both-bone open fracture that needed to go to the OR right away.  i stayed until his mom got there, then went back to camp.

i talk about being this mighty trauma nurse who's seen everything and is not phased by anything, and that night it just wasn't true.  sitting on the side of a big hill, in the dirt, with a crying and terrified child in my lap...it was SCARY.  none of my supplies, no resources, no higher authority than myself...everyone looking to me to decide what we were going to do.  you would think that someone who loves to be in control would be thrilled with such power, but i wasn't.  i was out of my depth.

so once it was finally over, i called my nurse bff and cried.  and then i felt better, and went on to nurse another day.  a day in which i had to deal with this:

it turns out that it's a bad idea to wrap a t-shirt doused in lighter fluid around a piece of wood to make an "olympic torch" and then run with it through camp, as one of the counselors learned the hard way.

such.  big.  blisters.

i hear both 'patients' are recovering well, and after a week i finally have too.

hats off to those who make a living listening to the panicked screaming of people who are healthy one minute and broken the next.  i have officially learned that is not for me.

you found it WHERE?

so awesome coworker goes to put in a foley on this lady who's admitted for a GSW to the butt.  the lady is a bit large and in charge, so awesome coworker is hunting around for the urethra, only to discover something very unexpected.  namely a bullet in the patient's vagina.

yes.  a real bullet like from a gun.  

just sitting there.  

in lady town.

NO idea as to how it got there, because there was no bladder injury, and no injury upon pelvic exam.

i'd call it a magic bullet, but i'm pretty sure that's that thing on TV that chops up food.

you don't see THAT everyday, people.  

more H&P gems

"patient states the symptoms started after she ate a Nachos Bell Grande from Taco Bell"

which was closely followed by

"patient states she has a dog but it does not lick her toes"

...whaaa??

it's like a bad match.com ad, and also the best thing i've read all day.  thank you, ID, for being creepy stalkers with a love for the overshare.

july, god help us.

the baby residents just hatched.  on the plus side, they are usually friendly and eager to please.  on the other hand, i get tired of hearing "i'm just going to run that by my senior...".  um, i asked you for tylenol.  lets use that shiny new degree, shall we?

thus, i have put together a little list i like to call 'helpful tips for new residents'.  the rules are as follows

1.  let me help you.  i know the floor, the patients, the team WAY better than you do.  i have been here 1825 times longer than you (literally, i did the math).  ask my opinion.  take my advice.  i want you to succeed so our lives can all run smoother.

2.  if you don't know, ask.  seriously.  this will save me a lot of time calling you to clarify your nonsensical/unsafe orders.  if you don't know the doses for things, check with pharmacy.  if you want to know how we usually do things, ask one of the nurses.  if you are worried about a patient call your senior.  if you don't, i will ask you to, or i'll do it myself.

3.  answer your pager.  SERIOUSLY.  if you are in the OR, have the nurse call me back.  if you're in the ED, you are one of 234098 people in the trauma and can take 2 seconds to let me know you're busy.  i will wait for stool softeners and FYIs patiently, if i have someone screaming in pain or crashing i will stalker page you and all of your superiors.  don't mess.

4.  let me know if you are overwhelmed.  if you are so far behind that you're about to cry, i will stall a family or save my discussion on lab values for another time.  you need to eat.  you need to take a moment to pull yourself together.  maybe you need to ask your peers for help, or ask me if there's something i can do for you.  talk to me.  at the very least, i can get my coworkers to back off of you for a little bit so you can catch up.

5.  there is no reason ever to be snotty or snippy or rude to me.  NONE.  use your words.  if you are frustrated with something i did, tell me.  you'll get an explanation or an apology.  if you're stressed, see above.  i can remember every resident who has crossed me by name, and i will not trust you for the next 5 years if you are evil.

6.  doctors and nurses can be (gasp!) friends.  i'm not asking you to go shopping, but we can have fun at work.  when i like you and we have a good working relationship with mutual trust, things will be easier for the both of us.  trust me.

7.  keep me posted.  if you're doing something with one of my patients, i want to know about it, especially if they need to be medicated.  do not pull my tubes/lines/drains without telling me.  when they disappear, it freaks me out.  a heads up is all i need.

8.  you don't have to mop the floors, but you'd better keep my rooms clean.  i do not expect to walk into a room covered with casting plaster and a freshly-pulled chest tube sitting out with the end in the garbage.  i am not your maid.    

those are the basics.  guess we'll see how this batch does.  

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.