Nursing Myself

It is, in my opinion, much easier to be someone else's nurse than to be my own.  This past week has been potentially one of the most stressful ever, making my "welcome home" week seem more like it should be a "why did I decide to do this again?" week.  I've dealt with taking care of Dad and also with changing my residency status.  I've dealt with messes and have cleaned some up.  However, last night I began making messes too.

Someone, somewhere tried to poison me.  I seriously thought I'd end up in the ER, as I was purging fluids in almost every possible way -- crying, sweating, puking, and you can only imagine the rest.  It's really hard to take care of yourself through that.  My thoughts were "How far do I have to crawl to get my cell phone?" and "I could drive myself to the ER, right? Ok, maybe not." and "Damn, the bathroom floor feels soooo good.  This should totally be a therapeutic option for my patients!"  After much reflection, I've come to the conclusion that I'm not ever allowing all of my people to leave town at once again.  You all are jerks for leaving me here by myself!  :-<

just kidding....kinda   

The Problem With Being a Nurse

In the past few months, I have been extremely blessed, beyond normal measure.  I was offered a new position in a rockin' hospital close to home, making more money in a community with a lesser average cost of living set before me.  I have received authorization to test for my critical care certification at a time when I actually have time to study.  There will be no gap in important things, like insurance coverage or paychecks.  The timing of events really has been perfect, for all intents and purposes.  

Unfortunately, life isn't always as it ought to be.  Circumstances can't remain perfect all the time, and I find myself needing to cling to God more through these "calms before the storms."  The problem with being a nurse is the inability to shut it off.  What happens when someone in the family is ill?  Everyone calls the nurse (or doctor) in the family to help sort through the medical jargon.   She then picks herself up and overextends her limits trying to fix the problem.  Perhaps trying to do it all herself because honestly, who could do a better job anyway?  

This is the predicament plaguing my future.  How do I take care of myself, love my career, and still have enough "caring" left to spare at the end of my day, when I'm needed by people such as my father who may no longer be able to care for himself?  How should I handle my feelings of anger, disappointment, disdain, and frustration for being placed in the position of responsibility?  I don't want to pick up the pieces to anyone's broken life.  I do it for people I don't even know every day and for a paycheck.  How do I protect myself from feelings of guilt and inadequacy?   How do I protect myself from burn-out? 

Even though things are rough right now, I am very hopeful a way exists for me to find balance and peace in my life.  At least he's pleasantly confused at this point.  Perhaps he'll be my muse for good blog stories.  Everything happens for a reason.  Isn't that what they say?  

I wish you 2 would share

Last night was a lot of fun.  No, I didn't get to sit around and play games at work, and no, I didn't even get a "lunch" break.  I was running my tail off from the time I walked in until the time I walked out.  It was fun because I felt completely in control and confident that I was making good decisions.  Finally, a sign of growth!  Haha!  Just kidding...kinda.

Anyway, one patient was rolled to me from the OR at shift change and started displaying signs of septic shock throughout the night.  Systolic blood pressures in the 80s are not good.  It was exciting to be able to give her family answers and to teach them about what was going on in her body.  It was also fun to see how the medications we used and the fluid boluses really helped her.  It's neat to see how the body can correct itself given the right help.  Furthermore, it is neat to have a patient who is so closely monitored.  I had an arterial line to closely monitor blood pressures, a CVP line to measure venous pressures on the right side of the heart, she was on a ventilator, and she was not on sedatives so she could still answer my questions.  And she was sweet, which makes everything go much more smoothly.

My other lady came in with a hypertensive crisis that lead to a hemorrhagic stroke.  She had been doing fine, but I noticed what I thought could be a neuro change, so I rushed her down to CT only to find out the problems she had probably weren't neuro related.  So I spent the night trying to get her pressure out of the 200s and down to a normal level.  It didn't happen, but I tried my best.  If only she could give some of her pressure to my lady who barely had any, we'd be all set.  Oh well, can't always get what we want, can we?

Public Apology

So my previous post landed me in the principal's office, for good reason.  Apparently, it is unprofessional to blog about co-workers, and honestly, I have to agree with the logic behind that statement.  It is unprofessional.  That's why I have a personal blog with no names, just stories.  I am very sorry the blog was left on the computer screen at shift change, and I am very sorry the person's feelings were hurt.   Honestly, I am. 

However, I do believe all things happen for a reason.  I would not have reported the incidents that happened to my manager had I not been yelled at by this person.  Rather, a rational, calm, cool-headed conversation might have been had, and no one would have been publicly embarrassed.  What also might have happened though, is the person would continue to believe it is ok to intervene without doctors' orders.  What might have happened is someone could have been seriously affected in the future by this incident not being reported today.  

Regardless, I will totally feel like a tattle-tale for at least......well, all of today.  It's a good thing I might sleep through most of it.  

Cramping My Style

I learned today that one of my biggest pet peeves as a nurse is following behind someone who puts my patients at risk simply by being a moron. Don't make up your own orders. Don't try to play the doctor--that's not your job. Don't try to teach me anatomy when you don't know it yourself. And don't teach me about diabetes when you don't know what a hemoglobin A1C reflects. I don't care if you have diabetes. You obviously have no idea what you're talking about.

No, it's not ok for you to hard-stop a nitro drip and then bolus/run maintenance fluids on my renal patient the day she just had dialysis. She has CHF. Wouldn't you first assume first that the purpose of that dialysis was to pull fluids off??? And then, wouldn't you think "Self, perhaps I should SLOW this drip down rather than shut it off???" Her BP will just rebound--and it did. And can't you please show me when you called the doc for her chest pain? Don't you realize she had a heart attack this morning and perhaps the doc would like to know if it's getting worse? Oh and can you show me the orders for the morphine you gave her since she has no PRN orders? Why didn't you do an EKG? And where is the doctor's note? AAARRRGGHHHH!!!!

Likewise, it is not cool if you can't tell your right from your left if it means that you're going to turn my other patient on his right side when he has a butt wound there. Turn him LEFT for crying out loud!!! And please, learn to do ostomy care correctly so I don't find poop on his skin when I enter the room.

Don't be that person I have to call when your shift is over. Don't put me in the position of thinking I should report you to my manager. Don't be that person who breaks down the team, who is unteachable, and who does nothing but demand the respect you do not deserve from your coworkers. It just pisses off people like me,those trying to save lives here.

Achy Breaky Heart

Unfortunately, the world doesn't pause for shift change.  Today my patient, who had been doing great all night, started complaining of chest pain at 725 AM.  Ugh!

"Can I get a stat EKG, please?  Oh, and page her doc!"  

After bumping up her Nitro drip, giving her some nitro sprays sublingually, and getting orders for morphine, we finally got her pain under control.  Luckily for her, she was already pre-scheduled for a cardiac catheterization and had already had her premeds.  The timing for her almost-tragedy could have happened at no more opportune time than when interventions were immediately available.   She did infarct, but at least it wasn't at midnight when circumstances weren't so favorable.  

Feet

I haven't blogged in about a month for a few reasons. First, I have been incredibly busy, and sitting down to write just seems too daunting. Second, I haven't had any really good stories to share. Lastly, I have been studying for CCRN, looking for a job, and getting set to move all at the same time as working some CRAZY overtime. Consequently, today's story will likewise be short.

Tonight I'm caring for the sweetest man you'll ever meet in your life. He's has been plagued by a host of medical complications stemming from a AAA repair gone bad, including bilateral above the knee amputations. Besides being cut nearly in half, he also is plagued with a family idiot. Someone brought him in a snuggly fleece blanket with the best of intentions. The only problem is the blanket is covered in hundreds of pink, blue, and green FOOTPRINTS. Doah!

Tidbits of Random Info

• When someone codes, is best to stay calm and in control.  Panic does no one any good.
• It will never get easier to tell a person's family that they have taken a turn for the worst.
• Open wounds can be found on ANY part of the body.  Yes, it is possible to pack a wound on a scrotum.  Yes, they can put wound vacs down there too.  Eeek!
• Charting--often the last task done, but the only that will cover your butt in a court of law
• It is impossible for some people to balance reality and religion.  
• HIPPA laws make it more difficult for me to do my job.  Thank you federal government.  I appreciate it.
• Poop often can be removed from a bed via suctioning.  When suction equipment is necessary,  you know it will be a not-so-fun night.
• Bathing people is best done in 3's with a 7 minute limit.  (Todd, Stef, and I can crank out some baths in no time).  
• Humor is the best coping mechanism.  How would we ever get through life without laughter?  Seriously!

Boredom

Due to the recent drop in patient census, the only adventure I can mention tonight involves sitting at home studying with a glass of wine in hand.  Sounds lovely, doesn't it?

My Best Friend's Name is Haldol

No matter how serious the nature of the diagnosis, some admissions to the ICU are just plain funny.  Such was the case with my admission tonight.  My poor little grandma fit every sterotype of crazy old lady that you can think of--90 lbs of pleasantly confused Alzheimer's/alcoholic dementia victim.  You know the kind.  They're the ones that are totally sweet until you get them all confused which makes them start screaming the really inappropriate things at the top of their lungs.  The following are the results of my first of many neuro checks of the night....

"Ma'am, can you tell me your name?"

"Yes."

"Well, what is it?"

"I can tell you."

"Really?  Then please do."

"Um. [pause] I don't remember right now."

"Ma'am, can you tell me where we are right now?"

"Yes."

"Well, where are we?"

"I'm in a room.  They keep moving my room around. But I can tell you in a minute."

"Sure you can.  Go ahead."

[strange mumblings that make absolutely no sense, minus a few intelligible words]

"Ma'am, can you raise your eyebrows for me?"

[Eyebrows pointed to the sky for at least a minute]

"Ok, you can stop now."

[Eyebrows still pointed up for another minute (now I'm laughing to myself)]

"Didn't your mama tell you that your face will get stuck that way if you aren't careful?"

"Oh." [Eyebrows down, and now she's pleasantly smiling.]

"Ma'am, we need to put a foley catheter in to drain your bladder."  This part was CLEARLY not understood.  I got "the look."  You know, the one where you're looked at like you have 10 heads.  Well, then she got antsy, of course, and we had to get out the fancy bracelets and vest.

"These will match your outfit.  You will look so pretty. Matches your veins AND the blue of your gown."  Unfortunately, restraints usually tick people off more and make the confused even MORE confused.

Carlen to me:  "Looks like I'm going to have a moving target here."

At this point, Mimi is explaining that we need to start an IV so that my patient can get IV fluids.

Me:  "Carlen, would you like me to hold her legs?"  I grab leg number 1.  Mistake.  Apparently that leg doesn't want a foley catheter as evidenced by what I call the bucking bronco move that she attempted.  I was holding on for dear life, trying not to get a sideswipe to the head.  "Hey, Marcella!  Will you help me, pleeeeease?"

Marcella grabs the other leg, which equally does not want a catheter, and soon we're in a battle of who can find the moving urethra vs who can dodge the catheter (mind you, the patient is now thrusting her hips off the bed).  At this point, I'm in tears from laughing so hard because the scene is just too hilarious.  The leg Marcella is holding looks double jointed, knee bend in towards the hoohoo--exactly where we don't want it as poor Carlen is trying to take a stab in the dark with the catheter tip while maintaining sterility.  The patient's one arm is trying to reach up and slap Mimi, who now has a needle in hand, while the other arm, which is still restrained to the bed, is reaching up for her nasal cannula to take the oxygen out of her nose.  I do remember Mimi taking off a shoe at one point and contorting herself into a near split to hold the patient's arm down while trying to start an IV.  And what am I doing in all of this, you ask?  Holding the leg that is now furiously pumping up and down as if she were trying to march her way up a large flight of stairs.  "Everyone is my witness.  All extremeties are moving and strong.  Who was it that said her right side was "paralyzed" again?  Idiot!"

My patient:  "Get off me you s***asses!"  (I'm thinking, "Huh?")  Now screaming, "These b****es won't get off me!" (clearest words I've heard yet).  I was stunned, but I couldn't hold back the laughter yet again!  Words like these should not be coming out of the mouth of a sweet little old grandma with pretty pink toenail polish.  Fighting the whole while, it took 4 nurses, one a contortionist, to put in an IV and a foley catheter--easily a one man job.  She's the strongest 80+ year old I've ever met, bless her heart!

Enters Shawn, "You guys having fun in here yet?"

My patient:  "You're a bastard!"

Shawn:  "Alrighty then.  Guess so!"

And then I gave her some drugs and all was well...

Thank you, Haldol!

Clara Barton

Today I am pretty fascinated by the work of Clara Barton, nurse, humanitarian, and founder of the American Red Cross.   I have been watching footage from Hurricane Ike on weather.com mainly because my family is directly in the path of this monster, with it's 20 foot storm surges and 270+ mile diameter of destructive winds.  My search for information had me stumble across this website....

www.1900storm.com/redcross

The storm that hit Galveston Island over a century ago, killing 6000+ people, was interestingly Clara Barton's last emergency relief effort.  It's as if she tired out at 78 years old, thinking "This is it. No more for me. This storm was the mother of all storms."  Since then, a 17 foot high sea wall was built to protect the island from such devastation ever re-occurring.  

 I am floored by pictures of the Gulf of Mexico literally pounding over the fortress that normally heeds a straight drop to the beach below.  Clearly, the efforts of the American Red Cross will be needed to restore devastation to this area again as even sea walls, levees, and the like cannot stop the power of the surge.  It seems that no place can ever be prepared enough for catastrophe.  

Barton's story reminds me of how nurses CAN change the world.  After all, isn't that what we seek?  We want to help people through the crises of their lives; to give hope when all has been ripped away.  Some of us want to feel indispensable.  Others just desire excitement, unpredictability, and having to critically think their way out of stressful situations.  It makes me want to be a do-gooder.  Maybe I'll go donate some blood, join the relief effort, or something of the like tomorrow.  Right now, I'm a sitting duck--outside contact for those who have either evacuated or are riding out the storm.

They Come in Threes

The angel of death definitely visited our unit last night.  I am not what you would call superstitious, but I have noticed, as has everyone else, that we can go a very long time without a death in the unit, but if someone is going to mayday, watch out for 2 more to go down as well.   We all tend to say, "Watch out!  You know it comes in threes."  Well, isn't that the truth?  Thank goodness I got out of the unit this morning before having to assist in coding our 3rd patient of the night, who had a blood gas that was incompatible with life.  How she still had a heart beat, I will never know.  

Apparently other things come in threes in our unit as well, such as the 3 "big whigs" (the president, CEO, & CNO) in the black trench coats, sunglasses, and funny hats who parade into the unit to bestow awards upon unsuspecting staff who have done a good enough job to be recognized in some form or fashion.  The ceremony is called a "Mission Accomplished."  It is a way for the hospital staff to recognize each other for fulfilling the hospital's mission statement.  And it is VERY embarrassing, but in a good way (except for the part where they take your picture).  

 When I heard the mission impossible music heading my way, I prayed it wasn't for me, but it was.  I thought, "Oh no!"  I felt the rush of blood to my head and I knew the flush of embarrassment had set in!  Thankfully, the mortification process didn't last very long, and I walked away from it feeling all warm and fuzzy about the good things a doctor had told my manager.  Recognition from a doctor makes me feel like I really AM doing a good job.  It also makes me realize how I have impacted a patient's life as well.   Who was the patient, you may be asking yourself?  The emergency craniotomy that kept me oh so busy last week.  Totally worth it!  

Balls to the Wall (Or something like that)

After my super-stressful 14 hour shift without a lunch break, I believe I am entitled to feel E-X-H-A-U-S-T-E-D!  Last night I received that patient that no one really wants to get right at shift change--a massive head bleed.  Head bleeds mean hourly neuro checks, tight blood pressure control, calling doctors in the middle of the night, and emergency operations at say, 1145 at night.  In addition, I had the patient that no nurse ever wants to have -- crazy Houdini man who tries to kick the staff in the head.  You can only imagine what that means.   Many, many lessons were learned from this experience.

First, I learned secondhand last night how important it is to control one's blood pressure before you "blow a gasket."  My patient went to work with a headache, and ended up in the ER with blood in her brain.  When she came to us, she was only a few hours away from needing to be intubated, put on ventilator support, and rushed to the OR to have a chunk of her skull removed in order to evacuate the blood, thus decreasing the pressure in her noggin.   Subsequently, I learned the importance of good assessment skills and of notifying physicians promptly.      

Thankfully, all went well in the OR.  However, the most challenging part of my night was transporting this patient down to get a CT scan 3 hours post-op.   I think my pressure might have been as high as hers at that moment!  It took 4 of us in total--a respiratory therapist breathing for her by ambu bag, 2 techs pushing the bed and keeping me from ramming into walls, and myself, watching the monitor, lines, vital signs, breathing, etc--to successfully make the trip.   I think we spent, in total, an hour of commotion just to complete a 5 minute test.   It probably wouldn't have taken so long had I been like a boy scout, always prepared.  Lesson learned.   

At about the same moment as I get this patient down stairs, my other patient decided to play Houdini and attempt escaping from bed.  Not a good idea, dude.  I think at one point he even disconnected his trach from the ventilator tubing using only his teeth.  I didn't know that could even be done!  My neighbors were awesome at de-escalating that situation for me before I returned.  Needless to say, the rest of the night was quite challenging, as I had to try to find a good balance of sedation for this person who was either going to stop breathing from being "snowed" or was going to extubate himself in the most creative way possible.

For a while there, I wasn't sure who had been more stressful of an assignment, the head bleed/craniotomy or the Houdini.  Both had their fair share of challenging moments.  

There is a happy ending to this rant though.  I learned how to assist a doc to put in an arterial line to monitor blood pressure.  I refreshed myself on how to complete an admission assessment (since we rarely have to do them).  I successfully used Nipride to control blood pressure for the first time.  And, I learned how to prep a patient for the OR.  By the end of my shift, I had titrated my head bleed patient off of all sedation to find that she was able to look at me, to follow commands, and to move all of her extremeties.  Her entire prognosis had changed twice before my eyes.  As for Houdini, he did end up out of the bed, but only with the assistance of 4 willing strangers from physical therapy.   The best thing I learned-- it takes a village, but we saved a life and kept another from accidentally ending his prematurely.  How cool is that?  

The Morgue

It is not very often, thank goodness, that I have the experience of going to the morgue.  It is one of the most uncomfortable experiences in the world.   Shutting curtains (without explanation, mind you) to shield the view of bystanders isn't so uncomfortable.  I wouldn't say that being escorted by security guards who are pushing a giant silver box makes the venture unpleasant either.  Nor is it unpleasant that I have to sign a dead body away by placing a sticker in a book full of other stickers from dead body collecting.  The unpleasant part is wheeling a dead body through the hallway conjoining our very open cafeteria, as if no one knows what is really under the shroud.  What a way to kill an appetite, no pun intended.  

Equally unpleasant is arriving to the morgue to find four too-small holes on one wall of a room about the size of my bathroom--can this really be called a morgue?  Am I literally supposed to fit this person in there?  Before becoming a nurse, I envisioned morgues as these huge rooms with many places to store bodies, as if they stayed there for lengthy periods of time.  Not true, my friends.  And I never expected that my signature would ever be needed to "release" such delicate material.  I guess this simply reiterates that TV does not equal reality.  

Won't you be my neighbor?

I've learned, in my very short experience, that taking care of my neighbors' patients is often much easier and more educational than taking care of mine.  I think it has something to do with the level of responsibility that I hold over my neighbors' patients versus my own.  For example, were my patient to get peritonitis followed by septic shock and rapid intubation in the middle of the night, I might freak out and forget what to do.  In fact, it's probable.  However, when it's my neighbor's patient, no problems are had.  I know the answers to all of the questions.  Have you told the doctor this?  Have you given her that?  Does she have suction?  Is this tube draining?  How much stuff has come out of here?  Do you know she has no pressure?  Do you want me to start that IV for you?  How about hanging some Dopamine?  Can we get some more IV channels in here?  I could not, for the life of me, figure out what was going on with my patient last night, but I sure did squeeze a bag of fluids into my neighbor's IV when I saw something was wrong.

The fun part about nursing is that sometimes I get to use a rapid infuser to pour 3 liters of fluid and 2 pints of blood into a person in relatively no time.  Sometimes I see a gallon of fluid leave a belly at one time.  And sometimes, the meanest doctor I know is nice enough to let me poke my head over his shoulder during an intubation just so I can see the vocal chords as he passes the tube through.  It's dirty and it's gross (I had to change my top and cavidide my pants), but the feeling of preventing a code, thereby saving a life, is the best feeling in the world.  It sure beats a desk job any day!

Lifepoint Collaborative

Some friends from work and I took it upon ourselves to voluntarily attend a Lifepoint Collaborative conference in Columbia, SC this week.  Lifepoint, formerly know as SCOPA or the SC organ procurement agency, is basically trying to dispel myths about organ donation so that more lives are saved through transplantation.  All in all, the conference was a very good thing, and I'm glad I went, despite the slideshow (which only those who went can possibly ever know the pain of sitting through that.)  

In the end, I was able to contemplate my own life and, well, death.  What do I really want after my spirit leaves this world?  The first thing that comes to mind is a viking burial!  I mean, who wouldn't want their body and sentimental items placed on a boat, set out to sea, and torched in front of a large crowd of wailers?  It sounds perfect to me.  Second thing that comes to mind is donating my body to the Body exhibit.  Do you think they can get a good pose of me spiking a volleyball so my diehard legacy lives on?  Also a good option.  If neither of the first two happen, I guess I'll just have to accept being cremated and having my ashes spread somewhere cool.  The only danger with cremation is the possibility of being shoved in a cupboard for years with other cremated family members, only to be passed down the family line.  Thanks Hilary for letting me know this actually happens in some families.  

Since option number 3 sounds like the most likely option, it only seems appropriate to be an avid advocate for organ donation.  We already know how much an advocate I am for entire body donation.  I just hope if I die tragically, someone can benefit from some part of me.  It would also be a good way for my family to cope with the disaster. 

Perhaps one day I'll decide to work in donor management.  It is probably one of the coolest jobs in critical care because the most difficult thing in the world to do is to keep a dead body alive.  Other perks would include writing my orders, managing a case from start to finish, and performing procedures I could only dream about as a regular staff nurse, such as line insertion, bronchoscopies, etc.  Furthermore, how beautiful it is to turn tragedy into life for so many others who have been patiently waiting for a miracle!