Grrrrrrr....

So, I'm getting my BSN online. It's great, because I don't have to sit in a classroom, there are no group projects, and this school has six semesters a year, so I can get stuff done faster.

We just started a new semester, and I bought my books through Barnes & Noble, because I have a discount card, so I don't have to pay full price for my texts. The school would like you to buy your textbooks and course materials through them, but $225 a class is just way to much for me to justify, since the "materials" are copies of the lectures on CD-ROM, and a bound handout like the one you would get in a classroom, with a printed copy of the syllabus and all sorts of PowerPoint handouts that go along with the lectures.

I've done two classes with this school, and I never found that I needed the "materials." I watch the lectures online with streaming video, I don't need the PowerPoint crap because the lectures are VIDEOS and I can just pause to take notes if I need to (which I don't, because mostly the lectures are just rehashing the book), and the professors in the last two classes posted important project information on the class message board.

This instructor seems not to be too into it: She hasn't posted a bio, or any information other than "see the study guide" for the two big projects we will be handing in. I politely posted a request for the information about the projects, to which I got three replies of completely useless information from classmates, and a statement from the instructor that "It will be most difficult to do the work in this course without the Workbook [sic]. . . . I think it is a necessary requirement to do well in the course."

Look, I understand that it sucks to ask someone to give me for free what other people have paid for. But I don't need the whole workbook OR the CDs. I just need the information about the stupid retarded projects. Perhaps a nice classmate would step up and email me the information. No dice. Even though I spent HOURS online explaining to these mostly computer illiterate people how to format a Word document and how to draw circles for a genogram for the last class: "Look up at the toolbar. Click on the word 'insert.' Click on the word 'AutoShapes.' Click on the button that has a little picture of a circle, a square, and a triangle on it."

So now I have to lay out $80 (which includes a $20 2-day FedEx fee, since it's considered an "emergency, " even though I told the rep I ordered it from that I wouldn't need it for at least a week, maybe two) for the CDs and a bound pile of xeroxed paper that I only need two pages from. As Yosemite Sam would say, that just burns mah biscuits.

Six Random Things About Me

Here's my six things, but first, the rules:

Link to the person who tagged you.
- Post these rules on your blog.
- Write six random things about yourself.
- Tag six random people by linking to their blogs.
- Let each of the six know they’ve been tagged by leaving them a comment (on their blogs).
- Let your tagger know when your entry is up.

1. I love rabbits.
I just love them. I have a huge weakness for them. Just looking at pictures of them makes me happy. I have had many rabbits as pets, but when the last one died of old age, I just couldn't do it anymore--they are very high maintenance and are very destructive. Dogs are easier and almost as cute. I try not to look at the emails that friends send me of rabbits who need homes because I keep thinking, "Well, maybe ONE MORE wouldn't hurt." (P.S. I also like to eat them. They're yummy! But I've never eaten a pet.)

2. I am afraid of clowns.
Like REALLY afraid. I also hate those "characters" in amusement parks--you know, people dressed as Mickey Mouse, or as Bugs Bunny or whatever. I find them extremely sinister. I hate the fact that there's an actual PERSON in there, looking out through the mouth or neck of this six-foot-tall woodland creature. I even hate people who dress up like stuff to hand out flyers on the street--I've been known to cross the street to avoid this one person who dresses up like a hot dog and hands out coupons. My palms sweat. And clowns are just gross.

3. I have most of a bachelor's degree in music.
I finished all of the music part: a B.Mus. in music performance. Flute, to be exact. Yep, classical music. I did my degree recital, and then when faced with finishing the liberal arts requirements, I copped out and left school. Sometimes I regret it, especially now that I have to go back and do most of them as part of my BSN. Blech.

4. I played guitar in a rock band for almost ten years.
I played in more than one band over the many years I've been playing, but this band was the biggest one I was in. We toured with big national acts, broke up, got back together, tried to get signed to a major label, formed our own label to release albums on, got within a hair of getting a big record deal, drove each other crazy, and then broke up. We were like a little dysfunctional family. I knew it was time to quit when, on the night before a huge showcase, we were all sitting on the floor of our rehearsal space, staring at each other, and our lead singer said, "If I had a machine gun, I'd machine-gun alla y'all right now."

5. I had a drug habit.
Ok, it was more than a habit. One night I was sitting in my room (this was waaaay back when I lived with my band--a failed experiment that only lasted a little while), getting high, when I thought, "This would be a great way to die...I wouldn't mind that at all." The little sensible, sober part of my brain kicked in and said, "what the fuck is wrong with you! What a horrible thing to think!" I immediately got up, flushed the rest of my drugs down the toilet, and began a three-day stint of puking and shitting and shaking and sweating and aches and pains and being completely miserable, while telling my band that I "just have the flu."

6. I kept a piece of my boyfriend's skin in my wallet for about a year--maybe more.
He played hand drums--ashikos, congas, djembes, and had substantial calluses on both palms. He got sick with a fever, and when he recovered, the calluses on his palms started...peeling off. We were at a friend's house, probably drinking more alcoholic beverages than was prudent, and I decided that the best option would be to snip off the skin with nail scissors, much to everyone's revulsion and delight. The whole palm came off in one piece. It was AWESOME. Our host, while amused, said, "What are you going to do with that? I don't want it in my garbage! It's gross!" So I folded it up and stuck it in a pocket in my wallet. And then promptly forgot about it until a loooong time later when going through my wallet. It was all dried out but was unmistakably skin. Kinda neat.

I'm tagging...hmmmm...Cheating Death, Firefighter Girl, Ubergeek, Hip to Code, Tex, and anyone out there who wants to participate!

Quick Scene from an Urban ER

EMTs come in, rolling a flat stretcher with a young latino man sitting up on it, yelling and waving his hands:

"You can't do this to me! I know Robert DeNiro! WAIT! I AM Robert DeNiro! I was in RAGING BUUUUUUULLLLLLLLLL!!!!!"

This vignette brought to you by Crystal Meth (tm)!

On my own continued

I played hooky from the last conference session of the afternoon and sat on the B&B front porch reading my book and drinking wine. It was lovely. And then I went to dinner and had some awful crepes. And by awful, I mean holy crap were those bad.

And now, in the room next door, are a woman and her teenage daughter, probably here to look at the college this town is famous for. And I don't know what's creepier--being here all alone, like last night or being here with these two, especially since my private bathroom is across the hall and I have to pass their room to get there.

Gah. Guess it's early to bed for me tonight!

My Sweet Babies

Over at Cheating Death, he posts about his sweet rescue dogs. Both of our dogs are rescues; the older, bigger one I got from a pound eight years ago this coming June; the smaller one DR got from a woman who was fostering her almost four years ago.

If you're thinking about a dog, please, please consider a rescue! There are lots of dogs out there that need good homes--even purebreds!

On my own

I'm in a mid-sized college town for a nursing conference! I'm staying at a huge, slightly creepy B&B just on the edge of the main part of town, about a mile down the road from the Hilton where the conference is. The B&B is cheaper and more interesting than the Hilton. The proprietress told me I'd be all alone there since there were no other guests and she and her husband sleep next door. Creeeepy.

So last night I had a couple of good and cheap beers at a little divey place (yay college towns--cheap beers!), got some awful takeout food (boo college towns--bad food for stoned college kids) and watched tv in my creepy room that had a seaside motif even though we are nowhere near any body of water.

Then I got up at the absolute ass-crack of dawn (6 am--remember, I work the midshift so I NEVER have to get up that early) and went to the conference presession, which was a CEN review.

Now I'm on my own again til the afternoon sessions, sitting in a luncheonette eating eggs and listening to some teenager chomp on her fries at the next table. It's all I can do to not plunge my fork into her neck. I HATE noisy eaters. I'd better go so I don't get arrested.

A big deal

A young woman came in by ambulance. She awoke at 11 pm out of a deep sleep because of a headache that swept up from the back of her neck up over the top of her skull. She sat up, called out to her husband, and vomited in the bed. He called an ambulance.

In triage she was alert and oriented, pupils equal and reactive, able to move all of her extremities, but seemed...off. She vomited three more times, and said, "This is the worst headache of my life. I've never had a headache like this."

Uh oh. That's a line straight from the textbook.

Straight to the CT scanner, and BINGO! A bleed, heading on down to the pons. We called neurosurgery and medicated her for pain and nausea. The doctor told her she'd have to go to surgery, and she asked for a phone to call her husband. By that time she was a little out of it. "Honey? They say I'm bleeding in my brain. Yeeeaaaahhh....it's not a big deal....some kind of surgery, probably. No, no....you stay home with the kids. I'm OK....it's not a big deal, honey...what? The nurse is right here....okay..." She holds the phone out to me. "He doesn't believe that this isn't a big deal." I took the phone.

"Sir? This is GuitarGirl RN, your wife's nurse. Yes, it's a big deal. I'll give you to the doctor, he can explain exactly what's going on."

Yikes.

She ended up being fine, thank goodness.

Can I just ask

What is up with those FLDS women's hairdos? Honestly, I don't have anything to say (or rather, I'm refusing to give an opinion) about what's going on in Texas, but SERIOUSLY. The HAIR!!! They all have this 'do! Even the little girls. Are they all gussied up for the cameras? Is this basically their "sunday best"? I can't figure it out.

Birds and Bunnies and Flowers

Ah, spring is in the air. Flowers are blooming, the weather is balmy, the dogs get to romp at the park every afternoon, and work seems to have let up slightly. (Uh oh, did I just jinx it?) All of us are raising our weary heads and looking around a little bit. Even the Powers That Be seem to have taken note of my personal ennui (perhaps because I dropped a few hints about getting called for an interview at another hospital) and have stopped putting me out in triage and in charge every day. So I'm taking care of actual sick people. Oh, right, THAT'S why I became a nurse.

Poor Disappearing John, usually the bright light of good feelings and optimism in the face of annoying patients seems to have had a bad day.

And in contrast, I seem to be having several nice patient-care episodes in a row:

The sweet elderly gal with the dislocated shoulder: she was in so much pain, and her niece was so upset for her and concerned. The patient kept saying, "That doctor isn't going to touch me while I'm in so much pain, is he?" We knocked her out for a minute with a little etomidate, and then her shoulder just eased right back in. She woke up ten minutes later, saying, "When are you going to start?" I asked her, "How's your shoulder?" She replied, "Oh, it doesn't hurt at all! What happened!" I assured her she was all fixed, and as soon as she could drink a little water and walk to the bathroom, that she would go home. "It's a MIRACLE!" she said.

Another elderly gal, this one slightly demented and very anxious, sent in for a possible CHF exacerbation. Legs grossly swollen, but not a lot of fluid in her lungs. Was refusing to let anyone come near her--and would not take off her nonrebreather mask. I really wanted to get her on some nasal cannula, get a Foley catheter in, and get her some Lasix. All of which she was refusing. Then she said (in a high-pitched bird voice) "But I'm SO HUNGRY and I'm DIABETIC WHAT WILL I DOOOOOOOOOO?!?" So I traded her nonrebreather for a grilled cheese sandwich and nasal cannula and stuck in a Foley while she was busy eating it. She barely noticed. (she must have been REALLY hungry...) I left her sitting up in bed, cheese smeared on her face, munching away, like some sandwich-eating bird in a nest.

And probably most satisfying: A very distraught woman comes screeching up the ambulance ramp; security gets her mother in a wheelchair and wheels her into the ED. The woman is gray and limp. No palpable pulse. In seconds she's in a bed; in another minute, we're shocking her v-tach and giving meds and chest compressions, intubating. A central line is in, more meds, another shock, and...nice strong pulse back. Heart block on the monitor and on the EKG, but perfusing well and trying to breathe on her own. Within forty minutes of arrival, the patient goes upstairs to the CCU. AND--even better: When I went to inform my other patients that we'd had an emergency that tied up the docs, sorry for the delays, thanks for being so patient, all of them said of course, we understand, no problem.

I don't think I ever had more than five or six patients at a time in the last few days. Made me feel like a real nurse, able to care for my patients and talk to them, do full assessments, bring a pillow and a sandwich, anticipate their needs and make them feel better.

Aaahhhhh, spring.

Why even BOTHER?

Another elderly lady sent in from a nursing home for "no urine for three days, lethargy, and poor PO intake." When I went to assess her, there was someone at the bedside, who said she was "sent with the patient from the home." The patient was nonverbal, except to yell "LAWD LAWD LAWD JEEEEEEEZUS HELP ME LAWD" when you tried to move her around.

I asked the companion if she could tell me anything about the patient. "She sick, that's why they sent she to the hospital," was the response I got. Further questioning yielded no additional information.

I began wrestling with the patient to take her clothes off and get her into a gown. She was extremely strong, grabbing on to the side rails and pulling her arms and legs into her chest, latching on to my hands, and bawling "JEEEEEEZUS" into my face at regular intervals. I was sweating and huffing and puffing as the "attendant" sat in a bedside chair with her arms crossed, staring at me. "Her don't like she clothes taken off," she informed me.

"Ya think?" I said, blowing my damp, sweaty hair off my forehead. I managed to get the gown on, but by then she had grabbed the tubing of the IV the paramedics had started and was refusing to let go. As I tried to pry her fingers off of the tubing, trying to save the line, the attendant said, "You need to tie she down if she pull out the needle. Are they keeping she here tonight? I need to know if I can go home now."

Barely containing my anger, I said, "I'm not going to tie her down. As long as you're here, it's your job to make sure she doesn't pull out her IV. I don't know if she's going to be admitted, and I won't know until the doctor sees her. I'm going to call the nursing home and speak to your supervisor to tell her that you're going to be staying with the patient until she is admitted, IF she is."

The nursing home supervisor confirmed that the attendant had just come on shift and was to stay with the patient and help with her care until the patient was admitted or discharged back to the home. I inserted a Foley, cleaned the patient, started another IV and started fluids. I knew this woman would eventually be admitted for dehydration, but was in no hurry to inform the attendant of that. I knew she wouldn't do much for the patient, but I had no desire to grant this sullen, unhelpful, lazy person a night off.

I just don't understand why people think it's OK to take a job with clear responsibilities and then NOT DO IT. I guess there's something wrong with me.

Big Picture vs Little Picture

So we got a very anemic little old lady from the nursing home, who was also septic and whose INR was oh, a ZILLION. Total mess. She coded twice while we were trying to stabilize her. And she came back (or at least her pulse did) twice.

I was trying to get her upstairs to the ICU as soon as possible, because I really didn't want to code her again. I called report to the ICU nurse:

Me: Hi, this is the ER. We have Mrs. At Death's Door. She is older than dirt and has sepsis and anemia. She is a full code. She's had cultures, foley, central line, levophed, dopamine, blood transfusion, platelets, CVP monitoring, antibiotics, intubated, ventilated, you name it, we did it. Oh, and we coded her twice. And she has a pneumothorax so she has a chest tube. Her vital signs are pulse too high, blood pressure too low, 100% O2 sat vented. Skin is intact--oh, but she has a very large hematoma on her left hand from an IV attempt by EMS. It's very swollen and is actually heavy. Well, that's it! I'll bring her up as soon as respiratory gets here.

ICU Nurse: Did you put a warm compress on the hematoma on her hand?

Me: Hee hee, yeah right.

ICU Nurse: (silence)

Me: Why, yes, I gently applied a wrapped heat pack to her hand, brushed her three teeth, and did full range-of-motion exercises IN BETWEEN CHEST COMPRESSIONS AND PUSHING EPI WHILE WE TRIED TO GET HER HEART STARTED AGAIN.

ICU Nurse: (silence)

And that, in a nutshell, is the difference between the thinking of ICU nurses and ER nurses.

(please don't yell at me, ICU nurses. I'm not saying that ICU nurses are BAD, I'm saying that the nature of their jobs is very detail-oriented, where the nature of an ER nurse's job is very big-picture oriented. And that we're oriented toward snarky comments at times.)

Please, Respect the EMS Workers!

Be they paramedics or EMTs.

Look, I'm an ED nurse. I know how to handle all sorts of medical emergencies--in an ER, with all sorts of equipment and medicines and supplies that I'm familiar with. I'm not going to tell paramedics how to respond to an emergency on the street! I have no idea what their protocols are.

A while ago I was on the phone in my apartment when I heard a sound like a garbage can being dragged on cement. I looked out the window and saw a mini-schoolbus in the middle of the intersection. Uh-oh. I hung up the phone and ran downstairs. A minivan had crashed into the corner of our building, and the schoolbus (with no children on board), which had a dented front end, was sitting in the intersection a few feet away. People were standing around, looking. I yelled, "Has anyone called 911?" Someone had. So I went over to the minivan to see what was going on.

A man was in the front seat, bleeding profusely from his head. He was wearing his seatbelt, but he had no airbags. "Sir, are you all right? Tell me your name! Sir, can you answer me?" He moaned, and opened his eyes.

"What happened to me? What...?" His eyes were rolling around in his head, and his hands were shaking. Blood was dripping down his face and onto his lap. I briefly debated running upstairs for some towels or something, and then I saw one of the local Hatzolah volunteers pulling a kit out of his car. He handed me gloves and some bandages, and told me he was going to check on the people in the schoolbus.

As I bandaged the man's head, he suddenly became unresponsive. I felt a fast, thready pulse in his wrist and at his throat, and immediately though, oh shit. I have never felt more helpless in my life. If we were in my hospital, I would know what to do. But out here on the street? Are you kidding me? "SIR! SIR, can you open your eyes?!" I yelled. His skin was cold and clammy.

A bystander came by and said, "We have to get him out of there," and started trying to pull the door open and undo the seatbelt. I said, "NO! He needs a board and collar! We can't pull him out of there until EMS shows up." He was still breathing, and had a pulse, although it wasn't great, so I didn't feel like we had to drag him out and start CPR. The bystander was pushing me out of the way to get the guy out of the car. I asked him if he was a medical professional and he said, "I know CPR!! He needs to come out of there!!"

Thank goodness an ambulance showed up, and double thank goodness: it was paramedics I knew from work. I told them what had happened and in two seconds they had him out and on a board and in a collar--all while supporting his c-spine. They did it a lot faster and easier than I could have with the help of some CPR-knowing bystander. The CPR dude followed them to the ambulance, saying, "You gotta get going now! This guy is in trouble" (uh duh) and "Where you taking him? He needs TRAUMA!! Are you gonna give him oxygen? Need any help?"

Holy crap. I'm sure this guy meant well, but dude! STEP BACK and let them work! Even I know when I'm out of my element.

The Six-Word Memoir Meme

Why, I believe this will be my first meme! Thanks to Monkeygirl for taking my meme virginity. I was also torn between two:

Rock or nurse: Which one's worse?

My smart mouth: Methadonians hate it.

The picture is from a show we did around Xmas time, which is why (for some reason) we were wearing PJs on stage. Mine had pink flamingos with scarves and light-decorated Airstream trailers on them. Cool.

Typical!

Suburban Doc says it all in his post. Go read! And if you're a patient, REMEMBER IT NEXT TIME you're in the ED for a sprain or a stubbed toe.

If you've been waiting for four hours, it's NOT because we're playing Parcheezi and kibbitzing, ok?

Don't piss off your waiter

or he will spit in your soup.

That is how I look at medical care, too.

If you are a morbidly obese (I'm talking 500 pounds at least) person being transferred to the hospital from a nursing rehabilitation facility, and you need help to do every little thing, it would behoove you to at least not be hostile toward everyone who comes near you.

The minute you were wheeled in, we immediately called facilities management to order a large bed. It doesn't help for you to scream and yell about it, threaten to sue everyone who comes near you, and tell everyone that in two minutes you are going to "get out of this stretcher and start killing people."

When your bed does show up less than a half-hour later, and six people (doctors and nurses and techs and anyone we can muster up) struggle to transfer you into it, perhaps you could thank them, or perhaps help a little to move yourself instead of calling them all motherfuckers and yelling "WATCH IT YOU ARE KILLING MY BALLS YOU FUCKS!"

When your nurse (me!) comes over to offer you something to eat (now THAT's carrying coals to Newcastle...but I digress) and to start your antibiotics and help you pee by maneuvering a bedpan under your gigantic swollen scrote and tries to be nice to you, making sure you are comfortable in your humungous bed, please DO NOT EVER drop your cell phone on the floor, and when I bend over to get it, say, "Nice caboose!" and then mention that sometimes there are naked people on the discovery channel and I should stay to watch with you. (seriously, CABOOSE?!? It would be funny if it weren't so pathetic.)

Also, it would be really great if you didn't yak on your cell phone for an hour, cursing up a storm, thoroughly embarrassing the little old lady with the broken shoulder on the other side of the curtain. "Why does he have to say those things?" She whispers to me. "He doesn't seem very nice."