Just for Laughs

Today I went in to work for a few hours, the first time I had been back since the mono started. Lets just say it didn't go to well, and I won't be trying that again for awhile. I need to recover a bit more before I try that again!
However, while at work today I saw something that made me laugh. I work at a large academic center and frequently bump into, consult with, and care for patients of prestigious doctors. Today, I happened to look up and see on of our world renowned neurosurgeons and one of his fellows (also fairly well known) walking down the hall together. Actually, they weren't exactly walking, they were both quacking like ducks, flapping their arms, and chasing each other down the ER hallway. In front of patients, staff, and visitors! I turned to the nurse next to me and asked "is that Dr. S0-and-So quacking like a duck? She quickly assured me that it was indeed the prestigious neurosurgeon on his way to see another brain-injured patient. After a good, long laugh at the situation we both had to admit that he is one of the most cool doctors either one of us has ever been privileged to work with. His sense of humor never fades, and while he tolerates nothing less the than absolute best for his patients, he is always willing to go the extra mile and explain something or help out in any way. And yes, even willing to quack like a duck to make the work day less tedious!

Mono, Ugh

Well, apparently I am not "just a little sick", unlike what I told everybody. Apparently I have mono. Let me just say this, MONO IS NOT NICE!!! I have been sick for a week already, and am feeling only a very tiny bit better. I hope to feel better son, as my National Registry Paramedic exam is on Saturday. What a way to study for it!

Sick

My apologies to any readers I may have, as my posting has been rather non-existent lately. Between working, visiting family for Thanksgiving, and studying for my Paramedic National Registry Exam, I have been rather busy. Then, I got knocked off my feet this week by a horrendous cold/flu bug. Nasty fever, nasal congestion, sore throat, headache, and sore neck. This is day 4 of this bug, and I can actually lift my head off the pillow for about 15 minutes at a time. After 15 mins, I am totally exhausted and nap for awhile. I have actually called in to work sick for 2 days in a row. I have never called in sick before! I worked on a broken foot before, and insisted on a walking cast so I could keep working. But, today I decided that if I can't stay awake long enough to even drive there, I won't be doing them much good! This morning, it took me 3 hours to drink a cup of tea and eat a banana in between naps.
So, that's my excuse for not posting much lately! While I'm recovering, check out this guy's website: www.rayfowler.com Make sure to read his lecture notes on "Top 10 issues in EMS for 2009". He was one of the speakers at the EMS conference I attended, and this lecture was really insightful, and I have several thoughts on it that I will post at some later date. In the meantime, I hope you and your families are enjoying health, each other, and the holidays!

Home

I just arrived home from a great and very educational EMS conference. I thoroughly enjoyed learning so much and talking with other EMS providers. I have many stories, including competing in a competition while there. However, right now I'm off to bed for a good long sleep.

CONGRATULATIONS TO ME!!!!!!

YEAH!!!!! I have just (15 mins ago) completed my Paramedic program!!! I am now officially a Paramedic graduate!!! I am so excited!!! Now for a few days off, a fun EMS convention with friends, and then hit the books for some study for the NREMT.



Congratulations to me, Congratulations to me, (cue silly music and me dancing in front of my envious classmates)

4 beds...A day in my life

A day in my life at work as an RN:

I thought I would share a quick snippet of a day with you all (whoever reads this, apparently I don't have a site meter? If someone would help me with that, I would appreciate it. However, I am not sure I actually have any readers).
Anywho, this is a picture of a moment in my day. A picture that changes constantly as patients come and go,and needs increase and are met.

Background: It was a busy day, 30 people waiting in the waiting room, all the hall beds full. We are short again, every nurse has 4 beds plus the hall beds. We had 1 tech for all 80 beds, so pretty much all he did was transport patients upstairs. Our acuity was through the roof, again, so all of us were running around, so nobody had much time to help each other.

So, with that background, here is a snapshot of my 4 beds:

Bed number 1:
Exceedingly cute little old lady (92 years old!) who lived by herself! Cute LOL daughter present as well. She had bilateral pulmonary embolisms, with one being a saddle emboli. She was fairly dyspenic, with saturations in the upper 80s on oxygen. She still needed more blood drawn, the resident wanted something or the other; and she needed report called to the step-down unit upstairs. Oh, and she kept having R on T phenomena that resulted in runs of V-tach without a pulse. Code cart was between her room and room 2.

Bed number 2:
Another cute little old lady with her partner of 60+ years by her bedside. You could feel the love between the 2 of them. He carried out her every wish, while she just held his hand and stared into his eyes with love. This LOL was extremely sick, with a dissecting aortic aneurysm from her aortic valve down to her renal arteries. She had come in with sudden onset of "ripping" chest pain radiating to her back. Classic for this presentation. She had a known small abd aortic aneurysm that was supposedly stable at 3.1 cm.. Today, she had an aneurysm measuring 7.5 cm down her entire aorta. She diminishing pulses in her left leg, and very poor perfusion throughout her body as it was shutting down to compensate. She also had a BP of 180/86 and the MD refused to lower it cause "I don't think this is acute". Herald a continuing argument with the MD to try and get this LOL some immediate help before she died. She also needed another EKG, some fluid, and some more blood drawn. Oh, and reassurance to that loving husband. When the surgeon finally showed up (he took his time since the ER MD told him this was "non acute"). When he finally showed up, she got immediate BP lowering, and rapid transfer to the OR to try and save her life.

Bed number 3:
Extremely obese patient who cannot walk due to a weight over 500 lbs. Seems while having a relationship with her husband (also over 400 lbs), she fell out of bed. He managed to avoid falling on her, how I will never know. She had some small lacs that the PA student was suturing, and some bruises that would heal. No broken bones, fortunately. Oh, and a extremely needy husband who would walk into my other patient's room to drag me out and ask about getting a taxi ride home. Before you flame me, I treated them with care and compassion. Also, being overweight myself I did not judge her for her weight.

Bed number 4:
Patient with Guillan-Barre syndrome after the flu vaccine. She came in with leg weakness that over the course of 4 hours spread to include the entire body. She became unable to swallow, and was developing respiratory failure by the time I transferred her upstairs. After much care and time from me, the annoying judgemental PA who works with the hospitalist team comes to see her and write admission orders. The PA decides that this presentation "is entirely psychosomatic and she just needs to get over it. Please feed her now with a full diet. I am calling the shrink, and she needs a regular bed (not even with tele!) and cancel the ICU bed". Herald another argument with her, and a call to the attending in charge of the hospitalist team that day. The attending comes to see her eventually. Meanwhile, I am getting chewed out for not feeding this lady, not insisting she walk to the bathroom, and continuing to place the foley against the PAs orders (but with the ER MD's orders). Finally, the attending shows up and concurs with the Guillian-Barre diagnosis. She goes back to being headed to the ICU, gets immediately placed NPO (just like I did! sorry, miss PA!), she gets a central line, respiratory gets called, placed on Bipap, etc, etc. She got intubated shortly after arriving in the ICU. She also had a million things that needed doing and several family members who needed help understanding the rapidly changing care plan.
(also, before you flame me, I love PAs. Most are excellent care providers, and I am excited to see them show up as they are often better than the residents. However, this one new one needs to learn a few things before being let loose on her own).

So, that is a moment out of my day. I generally love my job, but it sure can get challenging sometimes!

Strange

Today I cared for a elderly women who had a history of both a frontal lobotomy and a circumcision. I don't see either one of those very often, so it was wierd...

CPR fun

This story just goes to illustrate the twisted sense of humor ER nurses and Medics develop. When you do this job day in and day out, dealing with people's lives day after day; you find you either have to laugh or cry. Most of us choose to laugh, not at the patients; but as a way to cope with what we see everyday.

Today, had a very septic patient come in. Initially somewhat responsive, verbalized a few words. We RSI her, intubate, and start the septic workup; central line (her veins were horrible), foley, EKG, labs, pressors, fluids, antibiotics, NG tube; etc and etc. While the doctor was using the ultrasound to find the femoral vein for the central line (horrible veins!), she lost her pulse. We initiated CPR, and ACLS, and etc and etc. We ended up coding her for an hour and a half before her family said "enough" and we finally let her die.

During that hour and a half of CPR, we got bored with just compressing and started trying to outdo each other with the quality of our compressions. We do not have capnography in our ER, so we were going by pulse and BP. This was a little old lady, and amazingly we were able to measure a BP during compressions. So, what do the bunch of twisted ER nurses and medics do? We started a competition to see who could perform the most effective CPR.

I am proud to say that I won. I was able to compress effectively enough to generate a radial pulse and a BP of 175/106. I was pretty impressed with myself! In the hospital, I don't generally do compressions since we are so short staffed. Most times, I am running around defibrillating, medicating, etc; while the techs do their awesome work and do the CPR. Today, we actually had some free nurses and not many techs. So, we all stepped up to the plate and did our turn. I am pleased to report that I can still perform effective CPR without tiring too much.

Too Young

So, the past few weeks at work have been rather rough. Usually patients don't bother me, but I have had a string of patients who have, for one reason or the other, gotten underneath that tough skin and bothered me. Here is the rough version I wrote late one night about one patient that bothered me. Warning: for tough stomachs only, this is not pretty. This was a 17 year old suicide patient, I was the paramedic student who declared her dead on scene from hanging herself. She was a frequent at my ER before she killed herself.

I didn't even learn her name, but I knew her. Knew her from previous despair-laden visits. Knew her from desperate cries for help before it got to late. Now, it was just to late. Too late to make a difference, to late to change anything. I didn't go to school to learn how pronounce 17 year olds dead, I went to school to learn how to keep them alive. Now, all I can do is comfort Mom, right after I told her the light of her eyes was dead. Dead despite her excellent CPR, dead despite all the attempts to keep her despair in check. Dead, even despite all I could do. It felt like total, utter defeat to walk away. Defeat that said despite all my training, I really can't change the end. I am powerless before something so much bigger than me. The decision was made, and I could do nothing to change it. Her hair flowed away from her head, making ripples on the cold, hard concrete floor. It was black, dyed to have red highlights. It was full of life, full, luscious, it would have bounced against her head as she ran in the sunlight, laughing, playing. Which is where she should have been, dancing, laughing, chasing and being chased. Out in the sunlight, the dawn of her life; not locked in some cold basement hanging from the rafters, despair so thick it engulfed her until she couldn't take it anymore. She had marks on her, repeated marks, marks that told the story of many other despair filled, dark days. Days where she couldn't face the sunlight, couldn't face the joy; but instead locked her self into her despair. Days where the only release from the pain was to hurt herself. Marks hidden well away from prying eyes, the inside of her arms, her upper belly. Marks calculated to hurt, to mutilate, to release the pain; but not to kill. I remembered the marks, remembered trying to get someone to help her. Remembered seeing those marks as the signs of something far deeper. Remembered thinking that if she doesn't get any help, someday it will be more than marks. I just never imagined it would be in front of me. I never imagined I would see the full depth of her pain released in such raw agony in front of me. The green rope was still hanging from the rafters, tattered where it had been severed in haste by a despair-laden Mother. The other piece was underneath, also tattered where that same Mother desperately tore it from around her lovely daughter's neck. Her chest was indented, where that Mother had done such excellent CPR. A desperate effort to save the pride of her life from her ultimate despair. Her tears mingled with her daughters on that face as Mother struggled and tried so hard to save her life. There was a sister, a sister in almost the same shape. The same marks on her arms, the same despair-laden face, the same drab clothes. The difference was it wasn't yet to late to save the sister. Screams echoed throughout the massive house. The screams of a sister recognizing how the despair ate her up. The screams of despair, of hopelessness. The officers stood in silent attention all down the hall way, Witnesses to the destruction of a young life. Silent senitals ensuring we had a way out if something happened. Silent recorders of all that was transpiring, and researchers of what had transpired. The only evidence of emotion was in their eyes, the tortured expressions written there. They to, did not train for this, they trained to try to save before this, before the destruction. The house was massive, beautiful. Furnished with everything a teenage girl could desire. Beside the rope were hanging enough sports equipment for a gym. And yet, obviously something went wrong somewhere. We can only speculate, reminisce about the times we tried. Try to remember what we could have done differently, what might have changed this horrible outcome. Remember how hard we worked, remember how we tried for her, tried to help her. And that is perhaps all that matters. I tried. I tried my best. I tried my best several times. I can't change the entire system. I can't change what was done. I can't change the outcome. But, I can try to change the person, one moment at a time, one try at a time, one smile, one touch at a time. I tried, and I succeeded in doing my best.

Craziness

So, to my dear friends and family; here is why I haven't returned your phone calls, met you for lunch, or otherwise communicated since March. Here is a typical week in my life:

Friday:
Up early at 0700 for duty at the rescue squad
1000: PT for my broken ankle, learn I may not get the walking boot/cast thing off for awhile yet
1200: Dentist appointment, I don't want my teeth to become like my patients teeth :)
On the way home, stop by the mechanics and learn that my car needs $3000 of repairs
Spend the afternoon studying, and writing a paper
1900: Start my work week, work in the ER of the trauma center for 12 hours

Saturday:
0700: finished with work day (night), What a night! Sometimes this place actually resembles the TV show ER. Sumdood was really busy shooting and stabbing people last night...Oh, and beating up the occasional person. Throw in a code and a couple MIs and you have my night. Plus, we were extremely short staffed. Being up for 24 hours straight is hard on my body!
0800: home at last, that hour drive is really hard when I'm this tired. Now, for some dishes and housecleaning before I shower and fall into bed for 5 hours.
1900: at work again, try to smile but fail miserably when I learn we have only SIX (6!!!) nurses for all 80 of our beds. 9 doctors, 3 PAs, and an NP, but only SIX!!!!! nurses. I just hope to make it through tonight without killing someone! Does anybody wonder why I'm looking for a new job? Plus, my ankle really, really hurts tonight. The Tylenol just isn't cutting it anymore. Why can't I take even Motrin for my broken ankle, dear doctor? I know the research studies, but right now I don't care! I am walking and working on the broken, torn mess I call an ankle, you could at least let me take Motrin!

Sunday:
0730: Off work finally. What a night!!! I had 4 beds, plus the 2 trauma rooms to care for. I am crying as I leave work, I so want to be a good nurse and all I can do at work is run around and pray nobody dies because we don't have any staff. My GSW to the head made it to the OR, but shook me up a bit. He was exactly the same age as me, born on the same day. How in the world is he shot in the head, upstairs in the OR right now getting the bullet taken out? Other than that, a couple of cases of DKA, a massive subarchnoid that was transferred to us, a leaking triple A, a ruptured spleen with a BP of 29/19 upon arrival, and more made up my night. There are 60 people in the waiting room at 0700 this am, some have been waiting for 11 hours to get a room.
0800: Out to breakfast with some good co-workers. They have a few beers, I have some coffee to get me home awake and alive
0930: Home, didn't quite fall asleep behind the wheel. Housecleaning again, than to bed.
1900: Back at work, I cried coming in tonight. Fortunately, our numbers are better than last night, we actually have 9 nurses for 80 ER beds.

Monday:
0700: Off work on time. Last night was better but still busy. The RT said we intubated 8 people in less than 90 minutes time. People are sick, sick, sick lately. I don't think I saw one person who wasn't truly sick.
0800: Home, shower, bed for 4 hours to try to sleep, but the pain in my ankle is so bad I don't get much sleep
1230: Up, try to be awake, I have to swap to dayshift now so I try to sleep only a little on Mondays
Study for awhile
1430: PT for my ankle again. The fall at work on Saturday night did nothing to assist it in healing.
1500: Decide I should cook something for the week, might as well attempt at being healthy. I decide on spaghetti and while it cooks I fall asleep on the couch and burn it. Oh well, I can say that I tried!
Study all afternoon
2100: To the rescue squad for duty group tonight. Check off the truck and immediately get several back to back calls. Most did not need an ambulance, but the cardiac patient and the drunk dude did. You have to love running rescue in a college town, BAC of .44 in a 19 year old does not help him remember to breath!
0350: Finally get to make my bunk bed and fall into it.

Tuesday:
0600: Up after 2 hours of sleep. Hey, I got some sleep!
Home for a quick shower, change of clothes, and right back out the door 30 minutes later.
0800: Clinicals start in a town over an hour away. These are my paramedic clinicals so I have to look bright, shiny, smiley, and competent. Not happening today, in fact as I look down I remember that I forgot to polish my boots. Oh well... The medic today is really nice and helpful, he knows me from the ER and is very understanding of my exhaustion. He gives me a break on my skills, and trusts me on the calls. Cool!
2000: Off for the day, headed home
2100: Home, study for several hours for my big test tomorrow. Complete my paperwork that's due tomorrow.
0100: Shower, bed for a few hours

Wednesday:
0700: Get up, glad to finally get 6 hours sleep!
0800: Leave for class
0900-1400: Class, big test that I do well on.
1400-1700: Stay at school, not worth driving 2 hours to be home for 1 hour, study hard
1700-2200: Second class, another test that I pass, not as well as the first one, but I pass
2300: Home, finally. Time to do laundry, polish my boots, and find that pesky stethoscope for tomorrow.
0100: Shower, collapse in bed

Thursday:
0600: Out of bed, get ready for clinicals again. I can't keep my eyes open this am
0700: Stop and get gas, I am so tired that I buy not just my 24 oz coffee, but a liter of Mountain Dew as well.
0800: Clean, and wrinkle free I arrive at my clinical site. I try to smile, but that is hard when you are this tired. The medic is nice, and I answer his questions fairly intelligently. He is complementing me when he finally recognizes me for the ER nurse I am. Something about my walking cast being rather distinctive, I am apparently known as the RN/Paramedic student who wears a cast :) So, my preceptor then immediately ups the questions a level, and I still get them right. Yeah, score one for me! I successfully run several challenging ALS calls, including a nice MVC with a head injury, an unconscious person, and a "man down", who had gotten beat up by sumdood and was rather injured. I walk away exhausted, but I learned many things today and I feel more confident about being a medic.

Friday:
I start all over again, up early and stay up for 25 hours straight. You have to love my life!!

So, this is why I haven't returned your calls, or even acknowledged that you live. All I can think about is sleep these days. That, and passing this school so I don't have to do this anymore!!

New

OK, folks, I'm new here. Actually, only new to posting as I have been lurking for about 5 years now. Yep, I lurked at Emergiblog long before Kim had her own spot. (Hey Kim, was I one of the original lurkers? I don't remember exactly when I found you, but I do remember reading all your archives in under an hour). I have been reading AD for...Oh, I don't remember how long, but a long time. I also read all his archives in under an hour, at that time. I have also read Peter at Street Watch for years, John at Disappearing John since before he was nurse, Student Nurse Jack since before she started nursing school, and many others over the years.
I have only commented sporadically, and always as "anonymous". I would like to change that now, if I can.
However, you folks be warned, I am NOT a women with tons of time on her hands. I work full time, attend school full time, and volunteer with the local rescue squad over 100 hours a month. I will be posting, I promise, just don't expect to much from one women! I occasionally need an hour or so of sleep...
Oh, and I wish to remain as anonymous as I can, so if any of you folks know me, please DO NOT give out my real identity. Thanks in advance!

Grumpy? or Misunderstood?

She had loud, insistent voice; despite her low oxygen levels and labored breathing. "You will not stick me again, I won't have it!!" Her voice grew shriller as she restated the phrase.
I drew a long, deep breath and sent a quick prayer for patience. I replied sweetly "OK, I have personal policy of only sticking people twice and if I don't get the IV after that, I find someone else to do it." I refrained from adding onto the end of it "But, I'm the person they come find for their hard IV sticks"; although I really wanted to say it.
As I was cleaning up the large amount of trash I had generated, I took a moment to ask her kindly; "Is there anything else I can do or get for you while I'm in here?". I find this phrase often helps prevent repeated trips to the same room for trivial things. She glanced up at me and for the first time I noticed how baby blue her eyes were and how well they went with her wavy light brown hair. I inwardly kicked myself for not even noticing the PATIENT before. Oh, I knew what brought her in; I knew her vital signs, I even knew her lung sounds better than I knew her face.
Now, when I looked at her; I could see the frustration and the exhaustion etched across her face. She had many, many chronic lung problems out of no fault of her own. She hadn't smoked, had taken reasonable care of herself and yet, here she was again with her 5th ER visit in 4 months. She didn't come in until she was really, really sick. In fact, last time she ended up intubated for awhile. This time, she finally called 911 when she no longer had enough breath to tell the dispatcher where she lived. Her neighbor did that for her. She had improved and stabilized quickly with some albuterol, oxygen, and steroids.
She started crying, small tears rolling down her cheeks etched with wrinkles from years of living. "I have been using my home nebulizer 5 or 6 times a day, plus all my medications on time, plus my inhaler; and I still don't get any better!!" "I have a little granddaughter, she's 2, and a brand new grandson; and all I want is to grow old normally and be able to play with them! I can't even walk into their house right now, much less get down on the floor and play with them."
She had been demanding from the moment she could talk, "Get me another blanket", "Don't keep on sticking me", "I'm not a pincushion", "I hate that heart monitor", "Please fix the swelling in my feet", "Adjust the bed for me", "I hate that person, why does she keep calling my phone?" and on and on. Frankly, I was extremely busy, and my co-worker was too (a new RN just off orientation), her patient kept having runs of v-tach and I was needed elsewhere. But, I hadn't taken the time to truly see the PERSON lying in front of me.
I slowly took off my gloves and straightened the bed for her. I squatted beside the bed to retrieve things from the floor (don't ever kneel on ER floors, that's too gross to think about). As I did so, I looked into her eyes and truly listened to her.
She didn't talk for long, but just long enough to let me hear the cry of her heart; a heart saddled and held down by years of chronic illness. "I know I won't be perfect, but I want to stay at my good, and not keep getting bad and coming in here", tears kept rolling down her cheeks. It didn't take long and the tears stopped, and she looked up. "Thanks for staying and listening, nobody ever does, they are all too busy" she said, dabbing her eyes with a Kleenex.
She asked for another blanket, the bed to be adjusted, the lights dimmed, and some ice chips. I found all those things quickly for her, and got another nurse to come try the IV. He is a massive fellow with long, curly brown hair. He walked in and before I could have opened my supplies, he already had an IV in. It was small, but it worked. He smiled at her, said a few kind words, and walked out.
As I adjusted the bed for her, she spoke up again; "thanks for seeing ME, most people only try to fix me without seeing ME under here."
I was smitten, I had done the exact same thing. I had seen her illness, tried to fix it; but had not noticed her under there. Had not noticed that her demands were really a way to try to get attention onto her and off the illness. Had not noticed the very real human soul struggling with being sick again. Had not seen her eyes pleading for some love and attention for HER, not her illness.
Funny thing was, after I took the time to listen to her; she was a new patient. She didn't once call out, didn't ring her light; did just what we asked. Her soul's request for someone to see her had been fulfilled, and she was satisfied. She kept thanking us for seeing her underneath the layers of illness.