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.