Signature Suites

If you have ever wondered where celebrities can go for healthcare, ponder no longer.  Hospitals have special places for those who can afford the finest life has to offer.  My workplace, for example, has an entire floor called Signature Suites, where the rich and famous can have upscale amenities during their stay.  Honestly, it looks nicer than almost every hotel I've ever been in.  

How was I even privileged enough to catch a glimpse of such surroundings, you may wonder.  Well, I know people who know people who have powers to buzz us into the unit via the super secret, video surveillanced elevator.  All I needed was a sap story about being on orientation, which was totally legit.  

Anyway, imagine personal computers, fancy bed linens, flat screen tvs with dvd players and lounge areas for family members right in the hospital room.  Carpeted floors.  Granite countertops.  Marble tile in walk in showers.  And from what I hear, the food choices are close to gourmet.  

It was definitely eye opening for me to see the two worlds that exist in healthcare.  In one, every resource is available without question.  In the other, nurses and patients practically have to beg for supplies and extra comfort measures, for example radios, fans, and decent smelling bath products.  How is this fair?  *Sigh*

Catching up...

So I've been a slacker.  I apologize.  Lots of great stories are happening here, but not much blogging.  However, tonight I was reminded exactly why I blog.  My stories are insane.  Here are some of the highlights of patients I've cared for...

*16 year old with an open book pelvic fracture who ended up with abdominal compartment syndrome requiring immediate intervention...eek!

*Patient in ARDS on an oscillating ventilator, rotorest, and CVVHD... oh and by the way, he was on pressors, an insulin drip, had 3 chest tubes and 2 wound vacs.  Not busy at all.

*Motorcycle crash dude who ended up ripping off a leg on the road and was admitted to my unit via LifeFlight, then was put on our fluid resuscitation protocol shortly after (resus protocol = lots of blood products and fluids until you stop bleeding)

*24 year old car accident victim with a fatal head injury, who had a ventric/bolt placed at the bedside (I got to keep the drill).  She became the first donor patient I've had to manage, and I hear several organs were recovered.  This was also the saddest/most emotionally draining case I've ever been a part of for too many reasons to name.

* A woman who was 36 weeks pregnant got hit by someone involved in a high speed chase by the cops.  Her baby was emergently delivered in the ER, and she ended up in our unit with multiple wound vacs and on the vent.  I actually received orders (written, mind you) to put cabbage leaves on her breasts to stop engorgement.  WTF?  

While all of those were interesting in their own ways, tonight takes the cake.  I cared for a man who was in a Dick Cheney-type hunting accident.  He was obviously the one who ended up shot.  Anyway, the dude has abdominal wounds so extensive they started using maggot therapy on him.  Uggghhh!!!  So when the critters started escaping from the belly wound, I had the honor of catching them in a specimen cup so they wouldn't metamorphose into flies and contaminate our unit.  By far the absolute nastiest thing I have ever done in my life.  My patient had maggots.  Maggots!!!

At least my night wasn't horrible.  My filter never clotted off on the dude's CVVHD, AND I got to get in a ROTOprone bed last night!!!  It was so much fun, like a carnival ride, but it makes me nauseous thinking about having to be rotating for 20 out of 24 hours.  No thanks!  I'll post pics later.  

Oh, and I'm off orientation in 2 days!  Woo hoo!

My Job Totally Rocks

I've only had a total of 3 shifts in shock/trauma, but already I've seen some crazy things--rapid resuscitation with fluids, a bedside fasciotomy to relieve compartment syndrome, a bolt being drilled into a man's leg to put him in traction, internal decapitation, bilateral chest tube insertion, cervical spine fractures, and the like.   

While it's awesome to experience modern medicine in action, it is also a little discomforting to realize how unattached I can be.  I do want my patients to get better, but I find it even more imperative in this environment to detach and to find humor in the little things, such as reasons for admission --my last patient ran his car into a 300 pound hog.  Yep, that's right.  No lie.  He was pretty banged up because of it too, yet I couldn't help but giggle at his tattoo choices.  I'm starting to realize how twisted I am.  But that's ok.  

I love working for a facility with the capabilities to be aggressive with treatment.  I love having a doctor in the unit at all times, so I don't have to sit and wait for someone to call me back when my patient is crumping.  I'm excited (and, at times, a little scared) about the level of autonomy I've just been handed through nursing protocols and procedures.  For instance, I can now initiate electrolyte replacement without a doctor's order, and I'm allowed to draw my own arterial blood gases.  All of it is really overwhelming right now, but I believe this career move was definitely a good change.  This job rocks!

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.