Adventures of GuitarGirl RN

Slain by the Spirit!

2011-10-22T22:02:00.001-04:00

A little old lady came in by ambulance after falling at church and hitting her head. She said she had her hands up in the air and was praying, and the spirit took her and she fell backward, lacerating her scalp.

She said this happened a lot to her (and other people) at her church--they would be "slain by the spirit." The PA said he understood, the same thing would happen when his wife's family went to church.

"Yes," the lady said, "I love to go visit Jesus!"

I said I didn't think I would enjoy visiting Jesus if every time I came into his house he knocked me down.

HBO, Are You Listening?

2011-10-14T11:33:00.001-04:00

I have an idea for a TV show! A drama about a wisecracking ER night nurse who is also a vampire! She takes extra vials of blood to save and drink later, and she preys on the drug-seekers and methadonians because she is addicted to the narcotics in their blood! She can get an IV in ANYONE simply by smelling for a vein.

Sort of a cross between Nurse Jackie and True Blood, no?

We'll call it "Nurseferatu!"

*rim shot*

(ok, let's give credit where it's due: I was drawing blood from an elderly gent, and when he commented about the number of tubes I was taking. I made my standard comment that I'm really a vampire, and that I always drink the extra blood so it doesn't go to waste. His friend at the bedside looked at me and said, "oh! You're Nurseferatu!" So, no, I didn't come up with it--but it was too funny to not post!)

What NOT to Say in the ER

2011-10-09T21:27:00.001-04:00

"Can you help my father? He's bleeding out" when what he's "bleeding out" of is the band-aid on his hand covering the minor laceration he got while trying to fix a broken hairdryer with a butter knife.

It's a good day in the ER

2011-10-09T20:14:00.001-04:00

When I get to use my GGRN Special Bum Foot Cleaner and Deodorizer! In a plastic bag, mix one part shampoo, one part mouthwash, add an amp of bicarb, add warm water. Place patient's disgusting, crusty, stinky foot in bag and tape bag shut around ankle. Repeat with other foot. Marinate for a few minutes, agitate around feet, remove bag, and rinse!

Voila, CLEAN BUM FEET!

Sometimes I get those too...

2011-10-06T10:08:00.001-04:00

Drunken bums are fun. Yay.

2011-08-24T00:20:00.001-04:00

Best statement of the night from an inebriated man who was brought in by EMS:

Me: Sir, why are you here tonight?

Drunk: I dunno. I just wanted some chicken and fries and I ended up here. Do you have any chicken and fries?

Me: No, sir, I don't.

Drunk: Well, fuck you then.

Because we were busy, he ended up in a stretcher in the hallway right near me. He proceeded to have a very animated conversation with himself, and then sing at the top of his lungs. The song consisted of gibberish with the words "America," "real," and "sexy" thrown in for good measure. His singing style was actually reminiscent of Joe Cocker singing "You Are So Beautiful," especially the part where he sings "to meeeeeeeeeeeee" way up high and his voice cracks.

He was really amusing--at least until he shit his pants. Then he was just smelly.

Hey, nurse techs!

2011-08-10T02:55:00.001-04:00

Or "patient care associates" or nurses' aides or whatever your union insists you be called!

Listen up: you are working on my license, taking care of my patients, that I am responsible for! You're called "ancillary staff" for a reason--and that reason is to buck the fuck up and do what I say to do. It's in your job description. You take direction from nurses. Your job exists to help me. So please note that it doesn't help me when:

1) You fake vital signs. Seriously, it's just gonna piss me off that I have to check them again. I know for a fact that that pale, diaphoretic guy does not have a BP of 150/80 and a pulse of 87. Just do the damn vitals.

2) You disappear. I know your union gets you a million breaks. Your 15-minute break. Your hour break. Your other 15-minute break. Whatever. When you're not on break, I need to see you. Checking in with me every hour or so to suck up and then disappearing to go text and smoke and chat with your buddies on the back steps does not count as work.

3) You give me lip. When I tell you I need an EKG, the correct answer is, "I'll get right on it." Not "I'm on my break," not "can't you find someone else," not "In a minute."

4) You make up your own work hours. You leave your job at 12 am, same as me. If I ask you to transport a patient to sonogram at 11:30 pm, the correct answer is, "sure!" Not "I'm not going if she needs a chaperone because I finish at 12 and even if you send my replacement when she gets here right at 12, I'll end up getting out late." Listen, lazy. You don't work in a bank, where you get to stop working and close the doors at three pm. I don't get to leave if my relief doesn't show up. Suck it up and transport the patient. And don't bitch at me because I asked you to go to sono in front of the nurse manager, and she heard your little tirade and now you look like the lazy asshole you are. You should have shut your trap and done the transport.

5) You complain about scrubbing ass. It's your job. Sometimes I can help you. Sometimes I can't, and you'll have to ask one of your colleagues to help you. Yes, I can scrub ass. But I also can start IVs and assess patients and administer medications and insert Foleys and monitor patients and write notes and talk to the doctor about the patient's care, and you can't, because it isn't in your scope of practice. Your scope of practice is to do what I ask you to do, and I'm asking you to scrub some shit off the ass of this patient because I'm fucking swamped taking care of all these other patients. So scrub it, and don't give me attitude about it. If you didn't want to scrub butts, you're in the wrong business.

6) you can't do your job anymore. I know you're super old. So retire already. If I need help moving a patient, you're not really useful.

Yea, there are some wonderful techs out there-- the kind that you don't have to ask anything of, who love their jobs and also manage to anticipate every need you might have. But they get used up and burned out because of the assholes they're outnumbered by.

Ugh.

EMERGENCY!b

2011-05-31T21:12:00.000-04:00

Patient brought in by ambulance; complaint?

Sunburn.

That's just wrong.

2011-04-09T22:43:00.001-04:00

There's something wrong when your boyfriend uses the videocamera on his phone to record the doctor doing an I&D of the huge abscess you have in your groin near your vagina, complete with you screaming and cursing.

I don't know what's worse: that, or the fact that you've watched the video THREE TIMES so far. I can hear the tinny screams coming out of the little speaker on the phone.

People are stupid

2011-04-06T21:53:00.001-04:00

Lady (who is in the ED with a virus that involves diarrhea and vomiting) to her mother, who is holding a baby: "Mom, give her to me--let me kiss her goodbye."

Me and my tech simultaneously: "NOOOOOO!!"

Lady: "I shouldn't kiss the baby?"

Me: "not unless you want the baby to be as sick as you are rigt now!"

Greetings from My New Job

2011-03-18T08:29:00.001-04:00

I've been at this new hospital for a little over a month now, and there are some SIGNIFICANT differences from the one I just left. Some are good and some are not so good.

The new place is a medical center and is significantly larger than the old place. The ED is a level 2, same as the old place, but only has 20 more beds. But there are a zillion more nurses down here.

The standard assignment is six beds: three two-bedded rooms. Each room has a monitor. At the old place, the standard assignment was at least 8 beds, if not 10, and then you could be doubled up in an instant. Here you might put a stable, admitted patient in the hallway as they wait to go up to their room. Maybe. (One difference is that I've noticed that it takes much longer for patients to get beds and go upstairs.)

Despite this, the nurses in the new place have no idea how good they have it. There is a LOT of bitching about who got a patient and who has a sick patient and blah blah blah...also, as I am finding out, there is a lot of interpersonal politics. I guess when you have a lot of time on your hands, you can look around and find fault with your colleagues and then gab with your buddies about it. Whatever. I'm just glad I have time to actually be a nurse, instead of a medication waitress and procedure monkey like at the old place. Oh, and here I have a whole nurse tech to myself!! No sharing!! They do things without me begging! It's AMAZING! These nurses have NO idea how great they have it. Some talk about how this place is going to hell in a handbasket, and how they're looking for new jobs. Well, let me tell you, the grass is NOT greener on the other side.

There are big differences in the patient population here too. Before, I saw a zillion nursing home patients. Here, I think I've seen maybe one. A lot less bedsores. A LOT more junkies and bad alcoholics. This is due to the neighborhood. The population is a lot younger (packed with drunk college kids on the weekend). However, due to the junkie/alcoholic/homeless population, I've gone from being the best at getting tough IVs to being only fair at it. These people have NO veins whatsoever. At the old place, we'd get a lot of methadonians. Here, we have full-blown junkies etc looking for rehab, which we provide.

Here, the nurses can order labs and chest and limb x rays. This really speeds things up. However, I've been warned to look out for the super-old-school attendings who hate it when the RNs order anything. They tend to quiz you on your reasons for anything, so I make sure I have rationales for anything I order when working with them.

The residents seem ok, but the jury is still out on them. At the old place it was so crazy busy that a lot of face-to-face communication between the MDs and RNs was necessary. This created a bond between us, a sort of we're-all-in-this-together siege mentality. Here, the residents and PAs just order what they want and really don't communicate well, as far as I've seen. If I'm not constantly looking at the computer, I won't know anything's been ordered.

Another thing is that there's a separate psych ER for medically stable psych patients. They just go straight there. This is great from a work standpoint but not so great from an amusing-stories standpoint.

All in all, I think I'm going to like it here. I'm a little lonely because I have no buddies yet, and the commute and hours are killing me (we're staying with my in-laws in another city because our house is still being renovated--more on that later; and I'm working 7a-7p while on orientation, instead of my usual 12p-12a), but I'll fit in eventually.

All in all, I'm a little bored, actually. Oh well.

Finally!

2011-01-15T12:01:00.001-05:00

So, the last month or so has been incredibly stressful, but in a good way. We bought a house in our neighborhood and are in the process of renovating it so we can move in early next month after we sell our apartment. While nervewracking, because of the vast (to me) amounts of money that are being thrown around (and there still might not be enough to do everything we want without a loan), it's fun watching our dream house take shape! Backyard, nice big modern kitchen, and practice space in the basement! Wooohoooo!

And, the big news is that I've quit my job and am starting in the ED of another hospital early next month. It's a lateral move--same shift, same sorts of patients. But I trained at this hospital, and I already know my way around. The nurse manager is great, and the ED is brand new. During my tour, I literally was tripping over nurses. They're everywhere! And they're hiring even more!

Ok, there's a little bit of a commute: 45 minutes on the train versus 20 minutes to the next neighborhood. And, for the first three months, I'll be taking a bit of a pay cut. BUT: they pay 100% tuition reimbursement. At ANY school I choose. After only 6 months there, with no payback time required. Guess who's going Ivy League for her Masters degree?

Your old pal GGRN, that's who.

I have an idea about what I'm going to get my masters in. But I'm not 100% yet. I'm definitely going to be an NP, possibly with a dual degree in education. But I'm not sure exactly what specialty. More posts about making that choice later.

And I'm excited about changing jobs. New people, new stories, an interesting neighborhood to reacquaint myself with. It will be nice not to work in the same neighborhood I practically live in.

Wooohooo! Things are definitely looking up!

Bullshit

2010-12-08T00:04:00.001-05:00

Reason #2 why I need to find a new job is above. While I struggled tonight with 16 patients, some of whom were critically ill, this baby grand player piano was tinkling away in our lobby. You can't hear it, but right now it's playing "Do You Know the Way to San Jose." It should have been playing "Take This Job and Shove It." I really hope this was a donation from someone, because these cost around $15,000. I'm so glad we have one. Cause player pianos are really useful in a code.

You know it's time to find a new place to work when...

2010-11-21T21:57:00.001-05:00

...upper management and the CEO of the hospital are making $500,000 a year with million-dollar bonuses for "balancing the budget" and meanwhile in the ER they're only staffing 7 nurses when we need 15, they're turning away per diem nurses who want work, and we are completely out of gauze and rape kits.

Seriously. We had to send a security guard to the county hospital to pick up a freaking RAPE KIT.

I'm embarrassed to work here.

Glad you're feeling better, sir!

2010-11-11T11:57:00.001-05:00

A 60-year-old man was brought in by ambulance; they walked him in. He complained of "not feeling well" with some dizziness and nausea that had been going on for a few weeks. There were some suspicious stains on the front of his shirt.

When asked about his medical history, he said, "I've never been sick a day in my life, and I've never been to a doctor." He told me he didn't smoke, and "had a few drinks" every day.

You can see where this is going, right?

As I was finishing up his triage, he said he felt like he was going to vomit. I gave him a basin, and URP! Up came almost a liter of blood and blood clots. I called for some help and immediately started placing a large-bore IV.

I asked him if he had ever vomited blood like this before, and he said yes, all the time. When I asked him if this worried him, he said no--"because I always feel better after I vomit!" and then he asked to go home.

Yeah, that's not going to happen. (btw, his hemoglobin was 5.2. Oh, and those "few drinks"? A liter of vodka every day after work.)

Quick update...

2010-10-14T11:57:00.002-04:00

Sorry I've been away so long!

I'm busy with school, of course...only a few more classes and I'm done!

Our other dog passed away on Monday--she was only six years old and apparently died in her sleep. We miss her so much. Of course we'll get a new dog, but we're in the process of buying and selling houses/apartments, and don't want to bring a dog into the chaos of moving. Once we're settled, we'll start looking. In the meantime, Hubs and I are consoling ourselves with our "newer" dog, who we got this past February to replace our old guy, who died in January.

And, things at work have become intolerable--so bad that staffing is blatantly unsafe, management chooses to side with people who are a danger to other patients and staff instead of with the nurses and doctors who are trying to protect those people from danger (it's SO bad, but I can't write more about it...yet), and I'm looking for a new job. The clipboard nurse from upstairs who hates me? She's now in charge of the ED. Time to go. I'm using up my vacation time and getting resumes out there, and in the meantime, I'm keeping my head down at work and just doing everything by the book. I'm getting my certifications in order (TNCC, ENPC, CEN) so I'll be more attractive to a new employer.

I'm even debating ultimately getting out of emergency nursing when I eventually move on to my Masters degree. Suggestions, anyone?

More soon!

xoxo

GGRN

My favorite thing to hear

2010-09-15T16:15:00.000-04:00

(please note the *asterisks of sarcasm*)

"You're so SMART! Why didn't you go to medical school?"

This comment doesn't just come from little old people who don't know any better. Residents who are younger than I am have said this crap to me.

Just THINKING about this comment makes my head want to explode. Please, people. Don't EVER say that to a nurse.

I'm a nurse because I want to be a NURSE. If I wanted to be a doctor, I would have been a doctor. By god, if I wanted to be a freaking FIRE TRUCK I WOULD BE A GODDAMN FIRETRUCK!

Ok, sorry, rant over.

No Angels Here

2010-09-13T15:53:00.001-04:00

One stereotype of nursing (and it's perpetuated by nurses as well as by those not in the medical or nursing fields) that bothers me is that of nurses as "angels of mercy."

We're expected to smile while up to our elbows in bloody shit and vomit, be pleasant to rude and sometimes violent people, put up with crap from doctors, managers, patients, their families, nurse techs, and janitors yet keep our cool, never cry, never sweat, never lose our tempers with each other, always be prepared and be right there when we are needed.

We're expected to be a "cool hand on a fevered brow" or a sweet smile in a time of difficulty, or a shoulder to cry on--every day, every minute, every hour.

Look: I love being a nurse. I love being able to make you feel better. And when I have time (ie, when I have less than 12 patients all screaming my name and falling on the floor--and not in a rock star Beatles type of way), I can get you a pillow, and tuck you in, and be that cool hand.

But sometimes I'm having a bad day: bad news from family, got up late, working my third 12-hour shift in a row, have to pee, hungry, got spat on six times already. I'm a human being. I have a family, and a life outside of this hospital, although sometimes it doesn't feel like it.

So when this happens, you can count on me to be as kind to you as I can, and be professional, and to do my job.

But pardon me if my wings are not unfurled as majestically as you'd like, and if my halo is a little tarnished. I got some melena on it during the last GI bleed and I haven't quite gotten it to the laundry yet.

Sorry everyone!!

2010-09-12T15:43:00.002-04:00

I just noticed that my blog comments were set on "moderate comments on posts older than 7 days"; I guess I did that when I was getting a lot of spam! I totally forgot, and didn't know I even had comments to moderate.

Sorry, guys...I've published all the old comments. (I was wondering why no one was commenting...) Better late than never, I guess.

Just so you folks know: I don't delete real comments ever; I think everyone's viewpoint is at least interesting, if not valid--even if it's not complimentary to me or disagrees with something I've written. I do delete spam and requests for advertising (another thing I won't have on this site).

Again, sorry about that! Comment away!

Floor nurses are NURSES, right?

2010-08-27T13:20:00.000-04:00

I mean, they were when I worked on the floor. I'm just wondering, because lately, we're getting a lot of complaints about "unfinished business" after transferring a patient to the floor.

I'm not talking about sending up an unstable patient. I'm talking about busting ass on a patient who is going to a regular med/surg floor. Listen: you have most of the same training I do. You're certainly able to give meds, and put in a Foley, and page the covering resident for order clarification. Actually, you're MORE able to do those things, because your patient load gets capped off after about 6 patients. Mine doesn't; ambulances keep coming in. Also, I can have ICU and tele patients in my care, and unless you work in those units, you don't. Also, my patients are all more unstable than yours due to the nature of the emergency department. Here are my requests:

Don't complain to the nursing supervisor that a Foley wasn't placed on your patient in the ER, especially since the admitting doc was the one who ordered it six minutes before the patient went upstairs. We both were taught how to do this in nursing school. I know you haven't forgotten.

Don't call me complaining that the patient is "unstable" just because he has a blood pressure of 180/90 on arriving on your unit. His pulse is 78. He is asymptomatic. He has a history of hypertension. He's being admitted because his private doctor wants his hypertension under control. If his pressure had gone down in the ER, we would have DISCHARGED HIM. Call the covering resident and get some admitting orders. What, you can't give metoprolol or labetolol on your floor? You DO medicate your patients, do you not? I don't get excited about a BP of 180/90. I need at least 220/110 to start getting my panties in a bunch.

Look, I'll happily START a blood transfusion on your patient before he comes up. But once I've established that there is no transfusion reaction, the dude is coming up to you. I am not keeping him in an uncomfortable ED stretcher for two to four more hours just because you don't want to document the end of the transfusion. Also, I need the space for other patients who are coming in.

And speaking of which, if I call you and ask if a patient's bed is clean, and you tell me that the ROOM is clean and ready, but that there is no actual BED in it for some reason, don't get all pissy with me when I send the patient up in a stretcher to lie in that spot till YOU get building services to send a bed. If he can lie in a stretcher downstairs, he can lie in a stretcher upstairs, and don't threaten me with calling the nursing supervisor—I already called her and told her what I was doing. You won't get any sympathy from her. I need the damn space.

Seriously, folks, I'm busy. I have things to do.

Overheard in the ED

2010-08-22T15:01:00.001-04:00

I was attempting to place an IV in a patient who was a hard stick. I had missed the first try and was giving it another go.

Pt: you know if you miss this one you're going to have to give me oral.

Me: What!?

Pt: you know, oral medications. Instead of IV.

This has nothing to do with nursing

2010-08-18T12:00:00.000-04:00

but I just happened to notice that typing on an iPad is a lot like playing a fretless bass. You just hope your fingers are in the right place and fly along.

Perhaps we should call Surgery...

2010-08-15T22:22:00.000-04:00

...this looks like a deep one...

Why is it

2010-08-08T10:37:00.001-04:00

that people take the advice of the Internet over that of their own doctor?
I had to talk at least three people off the edge of hysteria yesterday for their uncomfortable but mostly benign conditions. One woman with a fever and rash was convinced she had some rare tropical disease despite the fact that her own doctor, whom she had gone to see twice in the last three days, told her she had a virus. Not Lyme disease. Not yellow fever. And no, not even strep. Stay home, drink lots of fluids, take Benadryl when you're itchy and Tylenol or Motrin for your fever. It will go away by itself in about a week.

Also, why is it that people can't seem to stand being sick, even a little bit? One man who had been seen in our ED for chest pain and diagnosed with pneumonia came back a day later because he wasn't feeling better. Not feeling worse; just not feeling any better. He had been given a prescription for a Z-pak (at least he was taking the meds; I can't tell you how many people don't take the medications that are prescribed for them and then complain they're still sick). I explained to him that pneumonia doesn't
go away in a day and than he would continue to feel pretty bad for about a week but that he would get a little better every day. His vital signs were all normal.

Also, why is it that some people think that if your child has a fever, and you give one dose of Motrin and the fever goes away but then it comes back six hours later OMG ITS AN EMERGENCY OMG IT CAME BACK! I have seen so many hysterical parents insisting that their kid must be seriously ill as the kid is sitting on my lap, smiling, drooling, and chewing on my stethoscope.

These are things I wonder every day...

Another Rule of the ER

2010-08-05T12:24:00.001-04:00

If you call me in triage to ask if I think you need to come in for your knee pain, and then complain about how the last time you came in for the same thing it cost you $700 (and we "hardly did nothing" for you), you probably don't need to come in for your knee pain.

Haiti Happy Endings

2010-08-04T11:27:00.013-04:00

No, that's not anything dirty--at least I hope not!

Even though there were a lot of sad stories, there were some funny and happy ones too!

We had an old dude in the ICU recovering from tetanus; he got better and went home. I knew he was better when he could open his big toothless mouth all the way to take the pills I was giving him. Did you know that metronidazole and not penicillin is the treatment of choice now for tetanus (in addition to the immunoglobulins and Valium, of course)? I didn't--I found out when I looked it up on my iPhone. Thanks, MedScape!!

We also had a young mother recover from heart failure secondary to postpartum cardiomyopathy who went home! (We saw three cases in two weeks; she was the only one who made it.) The doctor explained to her that God meant for her to have only one beautiful baby, and that to have another one might mean her death. We took her straight to the gyn clinic for an IUD. Here she is with her cutie patootie baby!

One young girl came in seizing, and when she wasn't seizing, she was unresponsive. We were sure this was another case for palliation, but we treated her for cerebral malaria, gave her fluids and meds, and three days later, she went home!

Another 19-year-old girl came in with horrible TB empyema. We gave her a chest tube and drained about 2 liters of pus and blood from her chest. Her 02 sat would not budge from 62% on room air for days, but after two weeks of antibiotics and TB meds, the chest tube came out and she actually went home to follow up with her local TB clinic! I don't have a picture of her, though. What I do have is a picture of me committing what would be a hideous crime in the US. We only had one suction cannister, and had two people (this girl and a young man who had been shot in the chest) with chest tubes. What to do with the cannister when it got full? Empty it out, of course--in the SEWER:

Yum! 1 liter pus and blood, coming up! (note my sexy outfit!

Glug glug, down the sewer in front of the ED. Mmmmmm. Good to the last drop!

And lastly, kids and babies! Haitian kids and babies are the cutest in the world. I became friends with three little siblings who lived in a tent near the lab; I think their mom works for the hospital and so they stay there. They would grab my hands anytime they saw me and escort me wherever I was going.

The refeeding tents were where we would go when we needed a little cheering up. To see all the little skinny babies getting nice and fat was great--and getting to hold the babies was even better!

We would vist the peds tents; I found some crayons and brought them over for the kids to draw with.

Black Triage part II

2010-07-29T13:00:00.000-04:00

That's a picture of a CT scan. Please excuse the box labels you can see through it; and the florescent lights behind it.

That's the neck of a 20-year-old man with a huge mass in his neck from the bottom of his jaw to the top of his collarbone; his airway is at the upper left of the picture--and that's at it's widest point. At its narrowest, it was about the width of a coin slot.

He came to the ICU from the "Catacombs"; the medicine ward where he had been languishing for months. He had a PEG tube through which he was fed, but was having a lot of pain and his airway was obviously diminishing--you could hear the stridor from across the room. The tumor was starting to come through the skin of his neck.

We had no hopes of doing anything for this guy; we were waiting for an obligatory consult from ENT--for a week. We were in the process of shutting down the ICU because the hospital management had decided to take back control of their facility; we had already pulled out of the ED, leaving it to the Haitian doctors and nurses. Hospital administration stated that they didn't have the staff or the desire to keep the ICU, and so we stopped taking admissions. This young man was one of our last three patients left.

We gave him IV fluids--he was convinced that there was some "medicine" in there that prevented pain, so we ran fluids slowly, continuously. His family fed him gruel through his PEG.

It was obvious that this kid was going to die. So over dinner we had the most macabre conversation I have ever had in my career: What are we going to do when his airway finally fails, or a blood vessel in that vascular tumor bursts? What do we do to help this kid for the five or so minutes until he dies?

This was not a hypothetical question.

One nurse who worked in ENT and had seen this sort of thing before suggested Versed, which was nixed because we didn't have a lot of Versed, and we couldn't waste the little we had on this. Morphine? No. So what we finally decided on was Etomidate, 20 milligrams. Sort of like a Rapid Sequence Intubation without the intubation part. The next morning we taped a vial of the etomidate and a syringe next to the bed.

Because we were closing down the ICU, there was no need for all of us to hang out there; people were needed to pack up our headquarters and redistribute our supplies. We took turns sitting with this kid and his family. When it was my turn, I listened to his every breath whistling in and out of they tiny opening that was his airway and prayed that that eensy slot would hold up. Would I be strong enough to do what had to be done when the time came? I was pretty sure I was--but I've never had to face this before, at least not with a human.

At last, the ENT surgeon came to evaluate the patient, and of course, after seeing the CT, declared that it was hopeless. Even in the United States, a tumor that bad would be inoperable--but it would have been caught long before it became inoperable.

So this was another one we sent home.

Black Triage part I

2010-07-27T16:32:00.002-04:00

When I got my Haiti orientation letter, one thing I noted with trepidation was the paragraph that stated "Medical care in Haiti before the earthquake was abysmal by American standards."

Abysmal.

And that's before people started living on rubble heaps, in tents, with poor sanitation and resources.

The same paragraph stated, "You will see people die who would not have in our country, with access to the resources we have."

One of my friends who had been to Haiti a month before said that triage in Haiti is true "black triage": it's necessary to decide who you can save before you spend the few resources available on saving them. "Of course," I remember responding. "That's the way it has to be."

What I didn't understand until I was there was how much that really sucks. There are decisions you make every day that you never thought you'd be making outside of an ethics class. There are decisions that are taken out of your hands by the failure of other people to act.

We palliated a lot of people: Severe stroke leaving the person minimally responsive? IV fluids, and wait for them to die. Sepsis not responding to antibiotics? IV fluids, morphine, wait for them to die. Sometimes we'd pass an NG tube to feed people, but they would often aspirate. IV fluids, morphine, wait for them to die. Our rule of thumb was to not intubate anyone who would need to remain on the vent for more than 24 hours. We only had one vent.

Who do you intubate? The 2-year-old in status epilepticus? Or the 39-year-old man who is status asthmaticus, gasping like a fish with an 02 sat of 55%? (We intubated the todder. She died. The man walked out the next day.)

There was a 15-year-old kid with renal failure. He was in the ICU when I got there, and I don't remember the cause of his kidney disease. He had had a dialysis catheter placed in his neck, and was doing well on dialysis, as we figured out what to do with him; there were rumors of a family member in Miami, and we were trying to think of how to get him there. Then the catheter failed. He was only able to get about an hour and a half's worth of dialysis one day. Surgery was called to either fix the catheter or insert a new one; after two days of waiting and wrangling, and as he became more and more unstable due to fluid overload, a new catheter was placed in his groin. We were so happy! He could go for dialysis the next day!

Or so we thought. The next day was Saturday. The dialysis area in the hospital was not staffed on Saturday, we were told when we brought the kid over for treatment. Even if it was, there's no electricity today. I pointed out that the World Cup was on--right on that TV over there! So there has to be electricity! No, no electricity. Sorry. The kid's doctor pointed out that he could die without treatment, please, is there any way? No, sorry. Also the last shipment of artificial kidneys was sold to a different hospital. What if we got one, we asked, what if we bought one from somewhere? No, sorry, no dialysis today. Sorry.

We took the boy back to the ICU and our coordinator began calling the other organizations in the area to see if they had access to dialysis anywhere, or supplies, or anything.

That night the kid coded. The night staff intubated him and got a pulse and blood pressure back, but brain death was confirmed the next morning by our staff, even though he was still breathing a little on his own.

So we decided to extubate the boy, and put him in the back of his parents' car, so they could drive him the twelve hours to their tiny farm in the mountains. He would die there, or on the way there, and this way the family would not have to pay the $25 that the hospital would charge to get the boy's body out of the morgue. Twenty-five dollars is about two or three weeks' wages. To get a child out of the morgue who would not have died had the hospital provided dialysis.

Did the boy's relatives scream and cry? Did they call down hellfire and the wrath of many lawyers on the hospital that basically contributed to the death of their child? Did they scream at us?

No. They took his body and thanked us. And that was the worst part.

It just illustrated how cheap life is when you have nothing.

Pictures of Haiti

2010-07-22T09:00:00.001-04:00

And now a brief tour of the hospital:

The gated entrance to the hospital campus, from the inside

The outside of our headquarters at the hospital; it used to be the "pavillion des internes," or the living quarters for the interns.

The lab. Labs had to be walked over, and woe betide the person who didn't get a number: no results could be received without it! There were no stat labs; mostly you had to wait for the next day. We had two I-Stat machines, but as you probably are aware, they don't work well in 100-degree heat. We kept it in a cooler, and then had to dry it off and gently warm it up, and even then it often didn't work.

The radiology department.

The medicine ward--or the "catacombs."

The TB clinic; outpatients would come here for their daily meds. The inpatient TB tents are just behind it.

One of the three TB tents.

Part of the ICU--the "higher acuity" beds that were just across from the med room/nurses' station. The guy in the first bed was unresponsive and febrile--he was seizure vs cva vs meningitis; I think he died. The young girl in the next bed had severe TB empyema; got a chest tube, convalesced, and actually recovered enough to be discharged to an outpatient TB clinic. The woman in the far bed had kidney failure; she was dialyzed a few times and was transferred to the medicine ward, only to come back in severe distress and die.

One of our two little vents.

The crazy oxygen setup. That 100-lb tank was supplying 02 to the entire ICU. The man in the cap in the background is a translator--he was the guru of the oxygen. Anytime we needed 02 strung to a bed, we yelled for him and he would make it work. The tank would run out a couple of times a day--usually we'd notice when the girl with the chest tube (two pictures above) would desat to 65, and point to her oxygen mask. We'd have to radio for the oxygen guy to bring us another tank. Nothing ever happens fast in Haiti.

More pictures and stories to come!

Haiti II

2010-07-16T13:51:00.004-04:00

Note: The first post in this series can be found here.

(EDITED TO ADD: I'm having problems posting pictures how I'd like to; the next post will feature photos and captions!)

The next morning at the ungodly hour of six am, I got up, shoved a breakfast of bananas, fruity pebbles, and one teeny tiny cup of weird coffee down my gullet. We got on the bus to drive the five blocks to the hospital, passing more rubble and tents on the way.

When we got to our headquarters at the hospital campus, I learned to my surprise that I would not be working in the ED, but in the ICU. I was a little disappointed, because I knew that the ED staff would be seeing a lot of great stuff--sad, funny, interesting--and that the nurses from our group in the ED were very independent practitioners, diagnosing, treating, and discharging the simple patients from triage ("fais mal"? Here's some ranitidine. Bye! Vaginal discharge for a year? Here's a scrip for the GYN clinic). They often did sutures, and occasionally were allowed to tap a lung with a physician supervising. I had been looking forward to all of this.

The ED was very similar to the ones we know--in character. Tons of people for whom it was the only access to medical care, a lot of BS complaints--and a lot of not BS. It became obvious that when a patient came up to triage, screaming "Mes amis!! MES AMIS!!" (which literally means "my friends" but in a vernacular sense means, "lookie here, I'm freaking out, please help me") that they were not that sick--so much so that it became a triage designation: Emergent, urgent, less urgent, and "mes amis." However, there was a lot of TB, a lot of typhoid, a lot of malaria, and--tetanus! There were treatment guidelines posted everywhere: "See Stroke, seizure, eclampsia, HELLP: think MALARIA and treat with 600 mg IV Quinine in D5NS over 4 hours. See fever + diarrhea OR constipation OR abdominal pain AND/OR perforation, THINK TYPHOID; give ceftriaxone 2gm IV or IM or Cipro 500 po/400 IV BID or Azithromycin; consider steroids for shock."

Anyway, despite my disappointment not to be placed in the ED, I realized I was there to help out in any way I could, and headed into the ICU (an extension of the main ED) to learn the ropes. Fortunately I had the fantastic Ms M, RN to show me. She is a nurse from Chicago who had grown up in Haiti until she was 13. It was great to have a nurse who spoke the language--we had translators everywhere, but none of them were medically trained, and so sometimes things got lost in translation.

I can't even describe the feelings I had on getting report and seeing what actually went on in this "ICU"--the first and only one in a Haitian hospital. It was a large, dark room filled with 19 low mesh cots. There were a few windows on the far end of the room--windows that had no glass, just badly damaged screens to keep out the mosquitoes. A 100-pound oxygen tank stood in the middle of the room; it had eight or ten regulators coming off of it and extension tubing was running all over the room, strung up from pipes hanging down off the ceiling. No IV pumps, no cardiac monitors. No running water. Intermittent electricity. One sharps container. One or two anemic fans that blew the sticky, stinky air around. (Florence Nightingale was rolling over in her grave!) My heart sank. This was no ICU--it was less than a med-surg unit back home! My first thought was, "Ugh, floor nursing! I'm going to be a medication waitress in Haiti! Oh, no, two weeks of this? Oh boy."

Then I realized how stupid I was being and decided to throw myself into the work, for better or for worse; all I could do was the best I could do and by golly, I was going to be the best I could be.

For my first day, the two other ICU nurses went easy on me and gave me six patients. I had "the twins": two 28-year-old women, not related to each other, but both with the same problems: HIV, encephalopathy, bedsores. One had an NG tube, and one didn't; that was how I told them apart. They had been there for months, slowly recovering. I had an older man who had suffered a stroke: aphasic, dysphagic, unresponsive. His plan of care? Palliation and waiting for him to die. I had a few young people with TB. I honestly don't remember a lot of the patients that first day.

I busied myself doing vital signs (I had bought a tiny pulse oximeter for the trip and MAN it came in handy), assessments, and giving morning meds, something I hadn't done for years. All the HIV and TB patients had a zillion pills to take, everyone was on Ceftriaxone 2gms IV BID--and we had no piggybacks! And hardly any NS! (Ceftriaxone can't be mixed in LR.) I ended up mixing it in a 10-cc flush and then pushing a little at a time over 15-30 minutes. It became almost a game: assess, push a little ceftriaxone on everyone; chart, push a little ceftriaxone; prepare some other meds, push some more ceftriaxone. And so on down the line.

Fortunately, most of the patients had their families with them. The family brought linens, washed and dressed the patients, brought food and fed them, helped them with toileting (usually squatting over a bucket on the floor), and would administer meds and tube feeds as provided by the nurse. The care these people gave their loved ones was inspiring and amazing. They worked in shifts; at night they would sleep on cardboard under the patients' beds. They were all eager to help in any way possible, and were so grateful for what little we could do for their relatives. What was even more moving was when a patient had no family, or their family was far away, the relatives of the patient in the next bed would try to help as much as possible. All of us nurses pitched in with the patients with no family: we'd bring them food from our headquarters, give them half of our lunches, try to get them out for a shower or at least a bed bath, and the translators would shave the men's faces and heads for them. The families would pray for each other; during resuscitations or codes they would gather belongings and try to stay out of the way. Once during a terrible code on a young woman with postpartum cardiomyopathy (something I'll write more about later), the tiny portable vent/c-pap machine kept tipping off the bed; there just were not enough hands as we struggled to get a line in her swollen body, and hang dobutamine without a pump, just counting drops the old fashioned way. I became aware of hands beside me, holding the vent in place--when I looked, I saw it was the young man with TB/HIV from the next bed, standing up, holding the vent up with one hand and the young woman's IV bag with the other. The generosity and community that these people showed with one another was remarkable.

Occasionally a patient would be discharged or transferred out to the medicine ward--the "catacombs." This was a huge ward of cots where patients could languish for weeks--even months. Dark, hardly any windows, a doctor would come by a couple of times a week. No nursing staff at night, and barely any during the day. (We found out that the nurses had not been paid since OCTOBER but would show up occasionally to keep from being fired so they could still collect their back pay--whenever that might happen.) Then another patient from the ED would come to take their place.

Up next: Photos, followed by vignettes from the ICU.

Haiti I

2010-07-16T11:52:00.007-04:00

When I left for this trip I swore I would keep notes and write up the events of every day just as they occurred. Of course, that didn't happen.

What I'm left with is a series of vignettes and impressions, some sweet, some sad, and some infuriating. My intention is to serve them up to you.

My two friends/coworkers and I arrived in Port-au-Prince at around noon and met our contact in the airport at baggage claim. And I use the term "baggage claim" loosely--there were boxes stuffed with fruit, plastic bags, crates, and all sorts of stuff rotating around the conveyor in the warehouse that was the terminal. The place was hot--107F hot--dusty, and smelly. Those three words would define the rest of my stay in Haiti.

We also met another volunteer: G, from Wisconsin via Boston, an adult nurse practitioner who works in a neurosurgery practice. She ended up being my roommate, for which I will eternally be grateful: I couldn't have asked for a better roomie!

Looking out the window of the minivan on the way to the hotel, we saw the rubble and devastation remaining after the earthquake nearly six months before. Tent cities filled with makeshift dwellings filled every open public space. One of the other volunteers who grew up in Port-au-Prince later told us of the former beauty of the public parks that surrounded the Presidential Palace and the hotel--a place to stroll with your family, eat ice cream on Sunday after church, and have picnics. All of these spaces have disappeared, covered with shanties and shacks and tents. People sell food from charcoal grills set up along the road; vendors hawk their wares from shacks labeled with what they are selling: cell phones, clothing, ice cream. Adults and children bathe in the street. Port-a-Potties are everywhere.

We headed to Hotel Le Plaza on Rue Capois. It was behind high cement walls with armed guards. We were left to our own devices until the crew returned from the hospital for the evening meeting. We were strictly admonished NOT to leave the hotel grounds for any reason; there had been a kidnapping of volunteers from another organization a few months before, and our organization was not taking any chances with our safety. So essentially, we were to be prisoners in a gilded cage for the next two weeks--shuttled between the hotel and the hospital every day. We were fortunate to have such a nice place to stay. Other organizations had their volunteers sleeping at the hospital in unused buildings, eating in tents and not showering for days.

We set up in the ballroom and waited for the others to return: we claimed our mattresses, changed out of our hot travel clothes, and unpacked a little. We strung up mosquito netting. I brought my own pillow and boy was I glad to have it.

We swam in the pool, ate a Haitian club sandwich (chicken, cheese, fried egg, bacon, lettuce, tomato) in the bar, had a beer, and then it was time to meet our compatriots for the next two weeks.

We spent the first night in the ballroom, enjoying the air-conditioning. We were up at 6 am the next morning, ready for our assignments and to spend our first day at the hospital.

I'm BAAAAAAACK!

2010-06-30T09:05:00.002-04:00

Haiti in a few words: WHEW! Sad. Hot. Smelly. Hard. Unbelievable. Inspiring. Frustrating. Beautiful.

More when I've had a chance to gather my thoughts. This was a toughie.

xoxo

GGRN

Haiti, here I come!

2010-06-14T23:32:00.002-04:00

See you all in a few weeks! I'll be leaving in the AM and won't be back for sixteen days--at which time, I will be home for a day, but then will leave again for a nice beach vacation with hubs and friends.

I'll post my stories and picture when I get back, don't worry!

xoxo

GGRN

No, thanks!

2010-06-10T12:07:00.005-04:00

I got an email today from a nice lady who offered me some HawthoRNe DVDs for my hospital's Lending Library! All for a review on this website and publicizing the release of the first season's DVDs!!

Firstly, my hospital doesn't have a lending library.

Secondly, no thanks. I watched some of the episodes when it first came out on TNT. For those of you who don't know, HawthoRNe stars Jada Pinkett Smith as an "inspirational nurse director who struggles with the balance between family and career." And no, it's not a comedy!!! She "struggles to hold the middle ground in a battle between bureaucratic administrators, heartless doctors, and apathetic colleagues that are caught up in a system that's forgotten whom it's there to serve." zzzzzzzzzzzzzzzzzzzzzzzzzzzzwha? I dozed off there for moment. Oh, wait--the New York Times called her a "spitfire who tramples over rules and regulations to reach her goals." Yeeeee HAAAAAAA! Sign me up! NOT!

The pilot opens with HawthoRNe racing to the rescue (at 5 am) of a suicidal cancer ridden young man who is on the roof of the hospital. Her hair is crazy. She forgot her ID and races past the guards to burst out onto the roof, begging the young man to step away from the edge.

He has the best line, however: "Last night my toilet bowl looked as if I filled it up with a really good Cabernet."

That's good, because it will go really well with all the cheese from the rest of the damn show.

Haw haw haw.

No thanks. But if the people at ShowTime would like to send me some Nurse Jackie videos, bring em on!!

NEW TOY!

2010-06-03T12:00:00.003-04:00

So, after much bitching and moaning and an actual Indian burn given to the nurse manager by the woman who organized this Haiti trip, I get to go. Whew!

And it's a good thing, because my new pulse oximeter got here today!!!

I'm driving my husband and our friend Chris crazy with my joyful dancing and constant checking of their pulse oxes.

I love new equipment!

Haiti trip down the drain?

2010-06-01T12:32:00.003-04:00

So, for over a month now I've been trying to get the time off for this trip. It's in two weeks. The nurse manager of the ED and the nurse supervisor (the one who doesn't like me) have verbally said they don't see any problem letting me go. I've submitted multiple paper vacation requests, which all seem to disappear.

But I'm still on the schedule.

I've offered to switch days. I've actually found per diem and part time nurses who are willing to cover some of the days--the ones where staffing is really low. I've haunted the nurse manager (who I think has one foot out the door these days) and written emails and done everything I can think of.

And I'm still on the schedule.

I'm getting up early in the morning tomorrow to be there when the two of them come in, and will demand an answer--in writing. I'll be horribly embarrassed to tell the IMC, who is sending me to Haiti, that I can't go, but if the answer is no, so be it. I can't just not show up for work--I'll be marked absent, which is really bad. I have no paper trail that proves anything: I've submitted copies of vacation requests, but I don't have one that is signed, proving I can go.

What's insane is that no one else will be on vacation from my shift during that time period. I'm also the third-most senior person on my shift, so no one can beat me out anyway. I have over three months of vacation time saved up. What the fuck is going on?

I really feel like I'm getting screwed.

We're screwed.

2010-05-27T10:56:00.004-04:00

So we have this new thing at work: Bedside triage. Previously, when a patient came in by ambulance, they stopped at a station at the entrance to be evaluated by the ambulance triage nurse. S/he would get the history from the patient and EMS personnel, and then decide where to send the patient: a cardiac bed with a monitor, the asthma chairs, or a non-monitored bed.

Ambulance triage was stocked with a monitor, computer, ID bands, first-aid supplies, and was next to the trauma/resus room in case the patient was really sick. There was plenty of room to move around the patient and if the patient was vomiting, or bleeding, or aggressive, there was room to get out of the way. There was privacy: the patient could tell the nurse about their private medical problems without the person in the next curtain hearing them.

Now, the patient is rolled in, registered, and the charge nurse sends the patient to the bed to be triaged there, either by the nurse in the area or by the "roving ambulance triage" nurse. EMS personnel is dismissed the minute the patient's butt hits the stretcher.

Does anyone see the problems here?

Formerly, the ambulance triage nurse had everything in one place. Now she has to run around the ED dragging her equipment and supplies with her, hoping to find a free computer with which to enter the information. While she's at the bedside, other ambulances are coming in and being sent to beds; the ambulance triage nurse can't stop what she's doing to ask what's up with the other patients in case one of them is sicker than the one she's triaging at the moment.

When EMS is dismissed immediately upon placing the patient in a stretcher, the triage nurse loses a valuable source of information about the patient in the event that the person is nonverbal, or speaks another language, or has some kind of altered mental status. The nurse is forced to rely on the nursing home paperwork, or the EMS written report, which can be sadly deficient.

Here's an example of what happened the other night when I was zooming around like an idiot doing this bedside triage that illustrates the two above statements:

I was at the bedside of a non-English-speaking patient. His family was there, but they didn't speak much English either. The complaint EMS gave the registrar was "vomiting for one hour." The patient was retching uncontrollably in the stretcher and looked much more sick than I expected. No one could give me any information about him, and as I approached him, he belched and I smelled a strange smell: pine-scented cleaner. The front of his shirt was soaked with it. I asked the family, "Why does he smell like this?" "Because he drank some floor cleaner," was the response I got.

Great.

Meanwhile, another patient had been put in another bed and I headed over there, dragging all of my equipment. The complaint was "cough, previous history of pneumonia." While I was spending time figuring out what was wrong with the man who had drank the floor cleaner, this woman was in a bed--with florid pulmonary edema, complete with pink frothy sputum, an 02 sat of 67% on a nonrebreather mask, and a pulse of 144. If I had seen her, I would have yelled for help and sent her to the resus room to be intubated. Instead, EMS put her into a bed, pulled the curtain, and left. Her companion was clueless about what was going on, and was calmly sitting by the bedside reading a magazine. The nurse in the area was completely overwhelmed with his 8 other patients and hadn't gotten a chance to even stick his head into the curtain to see what was up--he was waiting for the triage nurse (me) to tell him what was up.

Asking the nurse in the area to triage her own patients is asking for trouble. We have 52 beds in the adult ED, and we have SIX nurses assigned for patient care. Actually, about half the time we only have five nurses assigned for patient care, now that I think about it. Also, most of those areas can be doubled up when it gets crazy. I've been in a high-acuity area with TWELVE patients--ICU, telemetry, you name it. When would the RN in the area be able to leave her patients to triage another one? In addition, the new protocol calls for the nurse in the area to do her own EKGs. We have an EKG tech--why do we have to do them ourselves?

Management loves bedside triage. It makes our statistics look great: people get into beds immediately, EMS turnaround times are super fast. The director of the ED said, when a nurse pointed out that it was going to be tough for her to do her own EKGs, "So you used to have three things to do. Now you have four. Work faster. So what."

According to one of the managers, the powers-that-be based our new bedside triage protocol on two studies that showed it improved patient outcomes. One of the studies was done in California, where no nurse has more than four patients BY LAW, and the other? Done in a 30-bed ED where there were 15 nurses on staff at all times. Give me two patients and not only will I triage them, do their EKGs, scrub their butts, and care for them, I'll freaking teach them to speak French and give them a mani/pedi to boot.

In our ED, this new bedside triage is unsafe and unfair to the nurses. And it will go on and on, until someone gets overlooked and dies. And then a nurse will lose her job and maybe her license, and THEN we'll go back to regular ambulance triage.

Ok, I change my mind.

2010-05-20T23:29:00.003-04:00

I don't hate my job. I LOVE IT!

You know why? Because you clipboard motherfuckers CANNOT DENY that I know how to help save someone's life. You pencil-pushing, white-coat-wearing, sad-ass management types FAILED UP to your lame-ass jobs because you COULD NOT CUT IT at the bedside.

Please. Get away from that stretcher, because the last time you went near a critically ill patient was six zillion years ago. Take a hike and shove your clipboard and policy up your stupid fucking ass and then bend over and kiss mine.

Just back away now, and let me get this dude with a huge brain bleed to the OR. Because I KNOW how to set up and monitor an A-line, and I know how to titrate a cardene drip, and I know how to help intubate the fattest, no-neck patient and keep him sedated until we get upstairs to surgery. Step the fuck back and let me do my job.

No, Clipboard Nurse. You do not get to "jump in" and lend a hand. Me and my fellow bedside RN's got this one. Go push a pencil and SUCK IT!

xoxo

GGRN

I hate this job.

2010-05-20T20:06:00.003-04:00

I hate this fucking job. It eats you alive. What other job can you have where you can be the best at what you do and it's still not good enough? Where no matter what you do, you're wrong? Where even if you're doing exactly what you're supposed to do, and you get a good outcome, if someone (who doesn't understand shit about what's going on) gets upset because what you did wasn't what THEY think you should do, YOU'RE the one who gets raked over the coals and looks like the "bad nurse."

I swear to GOD if something doesn't change around here I'm leaving this unsafe shithole hospital and I'll go work in endoscopy or something, holding people's hands as they wake up from their propofol naps and giving them apple juice.

I don't need this fucking shit.

From the mouths of idiots

2010-05-17T14:46:00.002-04:00

So, last night what should roll in but a bona-fide hipster male, complete with thick scraggly beard and hair, pasty white skin, bony frame, and with bonus iPod! Drunk as a skunk, he was found by a concerned passerby curled up in a fetal position on the street with his face pressed into the concrete.

EMS stated that they had a hard time rousing him, but by the time he got to us, he was in full "let me outta here" mode, waving his hands around expansively, breathing his stench-laden alcohol breath on me, and explaining, "I'm OK now, please let me go, I need to see my girlfriend, I'm a bartender, it's ok, I don't need to stay here."

He failed my usual "walk a straight line" test miserably, as he almost toppled through a glass door, so I sent him back to his stretcher to sleep a little. I even offered him some food, which he declined, and told him he wasn't going anywhere for a while because he couldn't walk and had been found unconscious on the sidewalk.

He sat on the edge of the stretcher and tried to talk without slurring his speech. "No, listen, I need to go home. I have to work tomorrow."

"Yeah," I said, "Me too."

"No," he replied. "But you don't understand. I have a real job."

Uh huh.

Haiti!

2010-05-10T20:58:00.002-04:00

I've been asked to go with an international medical aid corps to Haiti for two weeks to work in an ER there. I'm very excited, as I've never done anything like this before. I'm going with a friend from work who is a pediatric nurse practitioner, and who has been on numerous medical aid trips like this before; she's also been to Haiti three times this year alone. She recommended me to their recruiter and I got a call!

In addition to being excited, I'm very nervous; I've only been out of the country (well, off the continent) once; I'm going to be thrown in the deep end of a crazy ER where improvising with equipment is the norm (for example, often the power goes off and people take shifts using ambu bags when the ventilators fail); I don't speak the language (I speak decent Spanish and pretty good French but for some reason Haitian Creole is really confusing to me); and I often get homesick when away from my own bed and my hubby.

BUT:

I'm a huge fan of doing things that are significantly outside my comfort zone; I'm looking forward to practicing nursing that will actually make a difference to people that really REALLY need my help; I'll be working with a few people I know and trust; and I'll have a great chance to use that thing between my ears--you know, my brain. I love critical thinking and relish the chance to figure things out quickly and efficiently.

I know I'll have a hard time for at least the first few days as I adjust to everything. I'm sure there willl be some crying into my pillow at night. I know there will be a few tearful emails to my husband: "Why did I do this? I miss you and the dogs! Why why why?" But I know by the end of the first week I'll be really in to the swing of things and ready to rock it out for the second week.

So, faithful readers: I'm asking you for advice. WHAT should I bring? WHAT should I pack it in? Have any of you done anything like this? Can you give me advice? Here's some of the advice I've gotten already:

It's going to be 90 degrees, so wear scrub pants and t-shirts. And a headband.
And clogs, but be prepared to throw them out when you leave. You'll be wading in rivers of blood and poop.
Bring a BIG "fanny pack" to fit all your equipment in. (I've been looking at this one).
Bring a headlamp, mosquito netting and spray, forceps, sphygmomanometer, shears, water purification tablets (I have some of this stuff, but not all of it, and though I will be staying in a hotel, mosquito netting is necessary because they may not have air-conditioning).
99-cent-store party favor toys for the kids.

I KNOW there's a million more things. Come on, faithful readers: I'm not leaving for another five weeks. Give me the benefit of your experience!

Is it a bad omen for the day

2010-05-05T09:18:00.001-04:00

...when your very first patient is an actively dying 73 year old from
the nursing home with a DNR?

Lord save me!

2010-05-04T20:07:00.001-04:00

I have been saddled with two of the world's stupidest, most
incompetent EMT students today. They have been with me in ambulance
triage for TEN hours and their skills have not improved one iota. I've
repeatedly shown Dumb and Dumber how to use the Dynamap, and they
can't manage to get the blood pressure cuff on right, let alone take a
simple oral temperature.

We were swamped, and I exhorted Dumber to work faster. He looked at me
and said, "I don't do well under pressure." I asked him why he was
planning to be an EMT then, and he replied, "Money." The EMS crew we
were working with cracked up.

The other one told me that he was taking this EMT class to "save
lives," but doesn't want to work as an EMT; he plans to start a
business as a "trip monitor." He wanted to be able to "talk people
down and keep them alive" when they overdose on Special K (ketamine)
because according to him, calling 911 is the "worst thing you can do"
in a situation like that.

Yeah.

They spent most of their time "trying the oxygen," horsing around, and
generally getting in my way or being completely useless on one of the
busiest days this month. They were both like, "wow, this is some crazy
shit here! Is it like this every day?!"

I couldn't take it anymore and sent them home two hours early because
they were driving me bonkers.

They headed into the back to get changed and I waited for them to
present me with their paperwork to sign. When I saw them walking out
the side door, I realized they must have known I'd give them a bad
review and decided to split. I found out later that they'd approached
the busy and harried charge nurse, who signed their already-filled-out
forms, and they left.

My only consolation is that these two bozos will probably never become
EMTs and I'll never have to see them again.

The Thin Green Line

2010-05-01T13:03:00.001-04:00

Last night a half hour before shift change we got a code--a STEMI (heart attack) that was unconscious with a poor blood pressure. It was a long, long code, during which we intermittently got a pulse back, raced to the cath lab, I donned a lead suit and helped the cath RN code the patient while three doctors tried to unclog the patient's arteries.

It was exciting, but what struck me most this morning was that while I was there, the patient wasn't the mound of flesh and humanity on the table. My patient was the thin green line on the cardiac difibrillator
monitor. I would watch the rhythm on the monitor change from a sinus(ish) tachycardia to a v-tach or v-fib, feel for a pulse and then announce, "docs, it's v-fib, charging, ready to shock, all clear?" and
then deliver the shock. I think I shocked her at least 15 times The other nurse was administering meds: code meds and the meds they use in the cath lab. I hung a few drips she was unfamiliar with, but the docs
made it clear that my job was supervising the two students doing compressions and that thin green line.

I've seen some weird things

2010-04-28T11:05:00.001-04:00

but never anything like this.

Rupture Weekend

2010-04-20T11:18:00.000-04:00

So, as I've mentioned before, the past weekend was pretty action-packed. We had the guy with a globe rupture, and then we got another kind of rupture.

I got report from another hospital letting me know about a transfer. This was a thirtyish woman with a two-day history of lower abdominal pain and a positive pregnancy test. She was coming from a small community hospital with no GYN services, and needed an ultrasound to rule out an ectopic pregnancy. I was told she was stable and in no serious distress.

An hour later, an ambulance rolls in with the transfer. She is paler than milk, diaphoretic, shivering; her belly is distended and painful. Because she's young and in great shape, her blood pressure wasn't terrible (yet) and she wasn't too tachycardic (yet), but it was clear that this was no stable "rule out ectopic." This was a full-blown ruptured ectopic.

Of course, we all spring into action with fluids, blood products, warming blankets, and immediately prepared her for surgery. I went up with her to the OR, and when the two GYN docs with me ran into the room to set up, I was left in the holding room alone with the patient. It was a Saturday night, so the place was empty. "Hello?" I yelled. "Is there a nurse around? I need to endorse this patient!"

I look down at the woman, and she's lying there quietly, with her eyes closed. I started attaching monitor leads so I could keep an eye on her until someone came. Suddenly she takes a deep, trembling breath in...pauses....and lets it out, her face slack.

I almost soiled myself. In fact, I think maybe a little pee might have escaped.

I grabbed her wrist to feel for a pulse, yelling, "Ma'am! Miss! Open your eyes!" as I desperately looked around for a code cart. I have never felt so alone in my life.

Fortunately she opened her eyes. "Are you ok?" I asked? She nodded. Her pulse was around 120 and thready. I started pumping up the pressure bags on all the blood and fluids that were hanging around her to squeeze out as much as I could into her. I finally noticed a nurse slowly sauntering down the hall and yelled for help. Thank goodness the docs came running out of the OR and they all took her in.

I found out later that they suctioned two liters of blood out of her abdomen, fixed the rupture, and she's in the ICU but ok and recovering.

The lesson I learned? I will NEVER go up to the OR with a case like this again without another ER nurse with me.

An Observation

2010-04-19T11:55:00.003-04:00

So, I slept in a little today since work was crazy over the weekend. For some reason lately the day shifts are woefully understaffed, and yesterday, because of a sick call and some kind of schedule mix-up, we had seven nurses. We're supposed to have fifteen--or at least ten would be nice. And of course, sick people were pouring in. So it was a little stressful.

I woke up feeling a little cranky and tired; my muscles felt stiff from running around like a maniac for two days. So I leashed up the dogs and took them out for a walk.

On a park bench near the grassy area where the dogs like to sniff around was this dapper yet peculiar looking young(ish?) male person. I immediately thought, "Oh great, another weirdo, crazy alert, look out."

And then it occurred to me: Why the bad attitude? I live in a city known for its great diversity, where anything can happen and usually does. I have the great fortune to be exposed to a multitude of cultures, cuisines, ethnicities. Why can't I look on the unusual people I meet in my life and work as another example of this great diversity, and smile, and feel fortunate to be able to have all these interesting things in my life? Furthermore, it's a beautiful day, I have two days off ahead of me, the sun is shining, the leaves are unfurling, my dogs are happily sniffing around and doing their doggie things. A gentle breeze is ruffling my hair. I'm healthy, my family is healthy, I have a job that I (mostly) love, I have a place to live, I have friends and people I care about. What's to be cranky about?

As I'm lost in my happy springtime multicultural reverie, deciding to love everyone and be a beacon of love to the world, a nice-looking woman approaches me and says, "Excuse me?"

I turn to her with a smile and say, "Yes?"

She says, "Can I tell you something?" And then proceeds to rattle off a screed about how at the shelter they spray her with some strange chemicals but they don't spray anyone else, and it's because the black people think she's white and the white people think she's black, and how the government is looking for her, and how after we're finished talking if anyone approaches me I should RUN because they will try to get me because I was talking to her, and how she doesn't know what to do, but that she knows that God will help her because he gives her messages through Jesus, His son, and how does she get these messages? Through a seashell she holds up to her ear. And then she asks me, "What should I do?"

"Ma'am, do you feel sick in any way?" I ask.

"No," she says, and smiles.

"Hm," I say. "Then honey, I don't know what to tell you to do."

She says, "Okay," and wishes me a good day, and moves along to the elderly Russian Jewish Orthodox couple walking with their adult son who is developmentally delayed. As I pass them with the dogs, I overhear her telling them they need to get their son a Bible and this will cure him of the devils that are infesting his spirit.

Fucking crazies.

Two yucky words

2010-04-17T20:18:00.001-04:00

Globe rupture.

Ew.

(For the uninitiated, the globe I am referring to is the one in your
eye socket.)

I hate visitors.

2010-04-13T00:49:00.001-04:00

Listen, I know it's helpful to have someone with you when you're in
the ED. But the key syllable here should be ~ONE!

Ok, so I'll make an exception for kids so both parents can be at the
bedside. But you don't need both parents, all the siblings, both sets
of grandparents and the next-door neighbor at the bedside in our tiny,
eight-bed pediatric ER. Also, having all of you stalk me and
individually ask me the same questions is going to drive me batty.
Also, all of you are freaking LOUD, and the parents with the septic
infant in the next bed do not appreciate the party atmosphere.

Speaking of a party atmosphere, there is a large community of people
in the neighborhood of the hospital who ALL show up when one of their
number is hospitalized. I'm not talking about ten people here. I'm
talking at least 50 that I can recognize, and that doesn't include the
various children they drag along with them. Whenever a relative is in
the ED, the chaos starts: there is a constant parade of relatives in
and out of the ED; the relatives in the waiting room monopolize the
TVs and eat food that some one of their group has cooked out on the
street in the back of their car. It would be just like a tailgate
party, except that the people with migraines and nausea and vomiting
don't need to be exposed to the noise of the partygoers and the smell
of their food as they wait to be called back to a bed.

The party crowd are an emotional and dramatic bunch, and it's not
unusual for fights to break out that require security to intervene.
Once a husband and wife had such a knock-down-drag-out fight, I had to
triage them both: him for "chest pain" and anxiety, and her for
screaming, "I want to die and kill you too!" as the police dragged her
out (because of course this is homicidal AND suicidal ideation and the
cops wanted her to get checked out by a psychiatrist first). And I
ended up triaging one of the cops, too, because she bit him.

Look, the ED Is not the place for your family reunion. Go rent a hall
or go to a park, or whatever.

Help Girls Rock Out!

2010-04-12T10:14:00.002-04:00

The Willie Mae Rock Camp for Girls is a great summer day camp that teaches girls to play rock and roll and DJ--they teach instruments, form bands, and have a huge concert at the end of the camp session. It's great! I've been trying to finagle my summer schedule so I can be a band coach for two weeks.

Now they are trying to raise money to go year-round with an after-school music lab--they need coaches, instruments, soundproofing, you name it. They're campaigning via the Pepsi Refresh Project, which is a funding platform for community projects.

I almost never campaign for any cause, but I had to get behind this one. Please, take a moment to visit the site and vote for the Willie Mae Music Lab!

April is always disappointing

2010-04-09T11:11:00.002-04:00

April is a deceptive month. I always think, "hey, the weather is beautiful, it's lovely outside, Easter is over--things should calm down in here soon."

Nah.

I think this every year, and every year, without fail, I am disappointed. We are always packed to the rafters seven days a week, with ambulances coming nonstop. Yesterday was the first day the waiting room wasn't stuffed to the gills.

But I got to be a "real" nurse the last couple of days. I educated a family about the last stages of death so they could be present with their mother calmly, holding her hand lovingly through the last hour of her life. I reassured an exhausted single mom with a (possibly) seizing child. I put in two difficult Foley catheters: one in an elderly woman who had broken AND dislocated her hip at the gym (no, she didn't break it while working out, she broke it twisting to open the door for someone!) and a 13-year-old with spina bifida and hypospadias who had a bad UTI with urinary retention. Got them both in on the first shot (and I inserted the elderly woman's Foley from behind! HAH!).

I also had to put up with the MOST unpleasant, most annoying nurse in the world, a real "C-U-Next Tuesday," as our pediatric attending would say. She begs for help and then criticizes the way you do it. She makes up rules about the way the ER works as she goes. She's mean to the techs, the clerks, the residents. She's slow and fixates on procedure and paperwork instead of actually helping patients or jumping in during a crisis. She makes me want to hang myself. The only way I can get through a day working with her (because I'm often assigned to float, and when she's there, she bitches until I float to help her--exclusively. With her three patients, while everyone else has twelve) is to remember that people who enjoy making others miserable are often miserable themselves, and that NO ONE in the ER even likes her a tiny bit, and how that must suck.

Almost Midnight on the Ambulance Ramp

2010-04-07T23:11:00.000-04:00

HA! Take THAT!

2010-03-31T10:10:00.004-04:00

There's this clipboard nurse upstairs who is out to get me. She has been trying to find ANY reason to "counsel" me (this is when management meets with you and your union rep to have a nice talk about how much you suck). First she wanted to counsel me because I was "late." Yeah, I swiped in at 11:33 am three times last month, and not 11:27 am. Late my ass. Oh, and there was the time I got a complaint letter about how mean I was--from the patient who hit me. Whatever. Oh, and the woman who complained that I pressed the stethoscope to her chest too hard.

Fortunately, our nurse manager is great and runs interference, and I haven't had to do it.

So the other day, she comes racing triumphantly downstairs, waving a letter and looking for me. Someone had written an email to administration about an encounter we had had. She hands it to my manager, and asks for me to be called over "because we need to talk about this--this is the THIRD letter we've received about GuitarGirl!"

My manager reads through the email and calls me over, laughing. He asks the clipboard nurse if she read the letter all the way through. She starts looking uncomfortable. He hands it to me.

Although the letter started out rather humorlessly with "I am writing to address an incident in room [number] of your Emergency Department on [date]," this was not a complaint. This was a letter effusively thanking me for my "Herculean efforts" (that's a direct quote) in disimpacting a young lady's badly impacted colon after the resident was unable to do it. The writer complimented me on my sense of humor and the way with which I put the patient and her partner at ease in a difficult, painful, and embarrassing situation.

I remember this incident. This poor young woman had been in a car accident and had had multiple surgeries on her leg in the last few weeks, necessitating lots of narcotic pain medications, which had backed her up something awful. I skillfully birthed a load of poop out of her butt (I remember saying, "OK, it's kind of like popping a big, poopy zit!"). After the initial blockage was out, a torrent of poop followed and actually flew off the stretcher and hit the wall behind the bed (fortunately the med student who was assisting me and I were well out of the way). Needless to say, it was smelly and messy, but I quickly cleaned up and put the woman and her partner at ease.

As we read the email, the manager and I started laughing--and so did the clipboard nurse, although it seemed she was reluctant to admit that this was not a complaint, it was a good letter!

Of course, she had to find something to chastise me about: at some point in the letter, the writer quoted me as having used the word "shit." She mentioned that that language isn't appropriate in the workplace.

I can't win.

Public Service Announcement

2010-03-23T19:18:00.002-04:00

Do not put pumpkin pie in your vagina.

That is all.

Shitstorm part 3

2010-03-14T23:53:00.001-04:00

Two days after hubby got out of the hospital, I had an important
appointment.

Hubs and I had been trying to get pregnant for about a year, and I was
mystified by our lack of success. Finally I made an appointment with a
fertility specialist. I had to have a saline hysterosonogram to
determine if the fibroid I have was preventing pregnancy.

Yup, it is.

The fibroid was pushing my uterus out of shape, preventing any embryo
from implanting. So my chances of conceiving are low, my chance of
miscarriage is high, and even after surgery to remove the fibroid, I
would still need fertility drugs and intrauterine insemination because
of my age, and my chance of conceiving could be as low as 30% because
of scarring.

The surgery involves laparotomy, and would require an extensive
recovery period with at least 8 weeks off work.

Not fun news to get. My husband and I have been talking it over, and
we've pretty much decided not to have the surgery. I might try one
round of IUI without the surgery, and if I conceive and miscarry, so
be it. And we may start looking into adoption.

So, you can see, things have been pretty stressful so far this year.
I'm kind of taking it easy and waiting to see how things pan out.

But things are looking up! Right now I'm holding my sweet 9-day-old
niece so her parents can get some well-deserved rest. She has
delicious milk breath and is making faces at me. Welcome to the
world, baby Audrey!

Shitstorm part 2

2010-03-11T10:23:00.002-05:00

As you already know, my sweet dog passed away. It was a Wednesday early morning. Our other dog, a six-year-old female, was sad and confused when he didn't come home with us. She moped around all weekend, looking for him whenever we went out for a walk, whenever we came home, and in every corner of our apartment. We tried to comfort her, and ourselves.

Early Monday morning, my husband woke up with excruciating abdominal pain and bloating. He was nauseous; he thought it was gas from the big meal we ate the night before. The pain was unrelenting--he suffered for two hours without relief. Finally, thinking it was pancreatitis, I convinced him to go to the ED. He was reluctant, as he's self-employed, and needed to call his sub to cover all of his clients for the day. But I insisted, so off we went.

Thank goodness it wasn't busy yet. I was already in my scrubs for my shift, which was to start at 11:30 am. They whisked him into a room, got an IV and some morphine in him and whipped out the old beside ultrasound. I was sitting across the room and I could see it: his gallbladder was so full of stones that it looked like a bag full of marbles. It didn't look inflamed (the wall of the gallbladder was not thickened), and the attending offered to let him go home and follow up with surgery in a few days.

Nope, I said. It's got to come out. And, one of the best surgeons in the hospital was available to take it out the next morning. Snip snap, I said. That thing is coming out ASAP!

So my husband was admitted to the hospital. Fortunately, he was able to have a private room--but it was on a floor that's notoriously understaffed--and when it is staffed, it's all brand-new grads. So guess who got to be his private nurse? Me, that's who.

We got him all squared away, and then the phone calls started. His mom, worried. His dad, worried. His sister, frantic with concern about the general anesthesia because he's a bad asthmatic. I told her that the anesthesiologists know all about asthma and would take care of him. She was less than reassured.

That night when I went home, our dog was really confused. Every time someone left, they didn't come back! She was very needy and withdrawn at the same time. I felt awful for her.

The next morning, hubs had his surgery at 11 am. After some confusion about where he would end up after the surgery (I had to call my friend in Patient Relations to figure it out for me), I found him in the inpatient PACU, miserable. His 02 sat was low, even on oxygen, so he was getting frequent nebulizers. He had received a lot of pain meds and was super sleepy. His elderly parents were there, fretting, until I sent them home.

I spoke with the surgeon. Apparently, the surgery had started out as a laproscopy--but then had to be converted to a laparotomy due to the size of the gallbladder. It WAS infected--and badly inflamed, and so huge they couldn't get it out of the little incision. So they had to widen it. He had two small incisions, another long one, and a drain in his belly. So much for going home the next day.

Poor hubs. He had never had anything worse than a mild flu bug before this; he'd certainaly never been in the hospital. Miserable, in pain, not allowed to eat, on awful antibiotics--and unable to urinate for eight hours after surgery. And you know what that means. Foley catheter.

And who put it in?

Not the floor nurse.

Who re-sited his IV when the potassium rider caused it to infiltrate?

Not the floor nurse.

Who noticed that the IV antibiotics that were hanging up there were expired?

Not the floor nurse.

Thank goodness I had four days off in a row. I was able to be with him for most of the time. I communicated with his colleague, who was covering his work, I communicated with his family, I communicated with his doctors.

Finally, on Thursday evening, they asked if we wanted to go home. YES! I said. I want him at home where I can take care of him.

And that began the next round of misery. The first night it was like having a new baby: He was up to the bathroom every hour and a half, and that required me to help him out of bed, rearranging pillows, helping him to the bathroom, helping him back into bed. Managing the medications, and the fiber and the antibiotics--and the new low-fat diet.

Finally I had to go back to work. His parents came to stay with him that day to help him with anything he needed.

It's been a long slog, but he was back to work on a part time basis after three weeks and then finally full time as of two weeks ago.

Whew.

Shitstorm part 1

2010-03-10T10:18:00.004-05:00

So, as I mentioned before, my life lately has been the perfect shitstorm.

As you know, my mom passed away in October. It wasn't unexpected, but it still sucked. My sister (who lives in North Carolina, and who at the time was 6 months pregnant) and I had to scramble to get the estate straightened out, get Mom's apartment ready to sell (holy shit, old people save SO MUCH CRAP!!), and deal with some minor issues (when my sister and her hubs were staying at Mom's for the memorial service, they used the shower, which leaked on the lady downstairs and ruined her ceiling and closet and she wasn't happy).

Then in January, my elderly dog started having seizures. Grand mal seizures. It was horrifying. We took him to the vet after the first one, and he said he thought it was probably a brain tumor, because the dog had also been having some neurological issues with his back legs and walking. We put him on phenobarbital, which of course made him dopey and barely able to function. But he was my sweetie pie, and I didn't care as long as he was comfortable and able to eat, drink, pee, and poop normally. He was 14 years old, and had seen me through being single, and nursing school, and dating idiots, and other crises and I loved him very very much. He kept seizing even with the phenobarb, and his walking deteriorated to the point where we were carrying his back end with a sling (which he hated). This was not easy, as he was a large dog (90 lbs). We also had to deal with a weekend during which our elevator was out of order, so my husband and I had to carry him up and down four flights of stairs twice a day, with him barking and howling in displeasure the entire time. It was not pleasant.

Then one night he woke us up at 3 am. He was howling and couldn't get up. He had slipped off his dog bed and was lying on the floor, but couldn't move enough to get comfortable. He drank water and ate a bowl of food hungrily, but we couldn't get him to relax enough. He was panting and miserable, and we made the decision to call the pet ambulance and take him to the all-night vet to have him put down.

Of course the minute the vet techs showed up with their cool sling, he got up and walked to the door. But he fell at their feet, and we still took him in anyway. He ate a banana (his favorite food) in the ambulance, and then another one as the vet was injecting the propofol to put him to sleep. He finally relaxed against me, his head against my shoulder. His body was so relaxed, he felt like a puppy again, the sweet boy I remembered from years ago, not the aging, arthritic, pain-plagued elderly adult he was. I kept my arms around him as she injected the phenobarb overdose, and I felt his heart stop.

I'd never had to put a pet to sleep before; this was my first dog ever. Even though my heart was breaking (and it still is--I'm crying as I type this), I knew we had done the best thing for him. He was never going to get any better. The vet confirmed this by saying, "It was time. You did the right thing." Now, I know they probably teach vets to say this in their first year of vet school, but man, it made me feel better. So, thanks, midnight vet, for being kind to me and my sweet boy at the end.

Sorry again

2010-02-11T13:50:00.001-05:00

Sorry I've been gone so long. My life has been sucking lately. I'll be back to my fun self soon (with explanations), I swear.

xoxo

GGRN

I wonder...

2009-12-31T19:00:00.001-05:00

Do we get so many gi bleeds around this time of year because the
colors are so festive? Bright red and dark green...lovely!

GuitarGirl RN's rules of the ER #3

2009-12-30T14:38:00.001-05:00

Ringworm is never an emergency. Never. Ever. An. Emergency.

GuitarGirlRN's rules of the ER #2

2009-12-29T12:38:00.001-05:00

There is just no reasoning with psychotics.

GuitarGirlRN's rules of the ER #1

2009-12-27T23:23:00.002-05:00

If you are 30 years old and your mom has to sign you in for a "problem
in the private area," you need to consider getting some scissors. To
cut the umbilical cord with. Seriously.

Merry Christmas!

2009-12-25T13:29:00.000-05:00

From ambulance triage...

I'm terrible.

2009-12-22T20:52:00.000-05:00

So, I'm the handful of years I've been an ED nurse, I've had my share
of people complaining to management about me.

Once a woman complained to my manager that I was racist, because I
triaged three sick elderly men (78, with severe dyspnea; 80, with
chest pain; and 85, syncope with a head laceration and altered mental
status) before her mildly sick 12-year-old son. The funny thing about
it was that all of them were the same race.

Then there was the insane retired nurse who wrote a complaint that I
was mean to her...after she hit me several times as I was trying to
help her to a bed.

All of these I can understand, to a point. People are feeling sick and
worried, and they're not at their best, and are unable to see past
their own needs at that moment.

But the latest one took the cake. I was summoned into a meeting with
management to discuss a complaint they had received about me.

When listening to the patient's lungs in triage, I "pressed the
stethoscope into her chest too hard and in a forceful way" that made
the patient uncomfortable.

Great.

Dear Surgery Intern

2009-12-14T00:33:00.001-05:00

I know you're all jazzed up and stuff to be let loose on your own! I
can practically see the drool at the corners of your mouth as you
contemplate putting in your very first chest tube! I can hear the
email you're writing in your head: "Dear Mom, today I was able to hone
my surgical skills while saving a life...my job is oh so rewarding!"
So don't look at me like I'm the enemy. Stop fingering that scalpel in
your pocket. (Oh gosh, I hope that's a scalpel!)

But dude, take a step BACK! Do not get mad at me because I won't
witness your consent. The person you want to stab with a chest tube is
not some big 20-year-old kid. It's a 70-year-old lady. She's pretty
healthy looking, even with a pneumothorax. But she doesn't speak
English very well and even I can understand that she's scared about
being in pain. She keeps asking, "Operation room we do it? I go a
little sleep?" You telling me she'll be fine with 5mg of morphine and
some local anesthesia at the site is not going to cut it.

Don't be mad at me for grabbing one of our ED attendings (who happens
to speak the same language as the object of your chest-tube lust).
Come on, he agrees with me: this old gal had no CLUE what was coming
down the pike! You do know you can't get informed consent using hand
gestures and some made-up foreign vocabulary! Ending every word with "-
ski" does not mean that you're speaking Russian, not even if your
patient is nodding and smiling politely.

Look: a little conscious sedation and we'll all get what we want, and
then you can stab away to your little heart's content. See? I knew
you'd come around.

Xoxo,

GGRN

Seriously

2009-12-03T19:38:00.001-05:00

If you are well enough to fuck in your ED stretcher, you are well
enough to go home.

Identify the object below!

2009-11-29T00:13:00.001-05:00

What is it?

That's right! It's a kidney-sized blood clot, sitting right on the
ambulance ramp near the sliding doors! Yum.
Don't slip in it on your way out!

(Don't worry, it's "happy blood"--from an extramural birth. The baby
was born in the cab on the way to the hospital, and mom and baby are
just fine.)

Your Private Doctor

2009-11-09T09:28:00.001-05:00

Your private doctor does not work down here in the ED. He is probably not going to see you here. He didn't call to "reserve" you a bed. Your doctor can't call here and "order" someone to see you right away.

Also, all the specialists in the world don't work here either. Blowing off your dermatologist appointment to come here and get your weird rash checked out because you "just want to get to the bottom of this" was probably not a great idea, since we're just going to send you to the dermatologist anyway.

In Memoriam

2009-10-19T11:51:00.003-04:00

Sheila was born on September 21, 1934 on a small homestead farm on the plains of midwestern Canada. She was the second of seven children. They grew up in a one-room log cabin, farming grain and livestock.

Sheila and her family lived the life of rural homesteaders: no electricity until Sheila was eleven years old ("It'll come down the road soon enough," her father said), and no indoor plumbing until the "big house" was built a year after Sheila had left home for the big city.

She went to the local one-room schoolhouse (by horse-drawn sled in the winter), helped on the farm, and idolized her Auntie Beulah, a nurse for the Red Cross who worked in Korea, helping Eurasian orphans find homes with families in Canada. She left home at 17 to go live with an aunt in the nearest city to attend 12th grade, as their local school didn't have that grade and most kids finished school by correspondence.

She decided to go to nursing school because the only other options for women were working in an office or a grocery, or becoming a teacher. She didn't want to be a teacher because her mother was one--and who wants to do what their mother did?

She attended a diploma school in which the students staffed the hospital and were managed by senior nurses. Sheila found she had an aptitude for nursing (although she hated working the midnight to seven shift she was so often placed on) and graduated with honors in 1956.

Sheila traveled around Europe, learned to ski, made friends--and decided to move to New York "for the adventure" in the 1960s. She intended to stay only for six months and then head on to San Francisco, but ended up staying in New York for the rest of her life.

As the head nurse of the critical care unit of a major metropolitan hospital, Sheila found herself in charge of the nursing students that passed through the unit. She fostered the careers of hundreds of nurses in this way. She also earned a BSN from Columbia University.

In the mid-60s, she was one of a handful of nurses in the United States who specialized in cardiovascular medicine, assisting cardiologists and surgeons at her hospital in open-heart surgery when pacemakers were just becoming routine. She also worked in one of the first cardiac catheterization units in the US, and worked with medical engineers and manufacturers on designing cardiac catheterization equipment.

In 1970 she got married and had her first daughter; in 1974, her second. She worked private duty at night for years when nurses were underpaid and had no benefits so she could be home with her children during the day, and began work on her Masters degree in nursing. When the kids finally went off to school, she decided she needed a career that allowed her to be on the same schedule as her children, so she did what she thought she'd never do.

She taught--nursing.

For thirty years she taught basic and critical care nursing, instructed on nursing units, and developed a "Math for Meds" course that is used in many nursing schools. She pioneered the use of computers in the hospital and for learning, and obtained a post-graduate certificate in Nursing Informatics. She estimated at one point that she had taught over 1,360 students how to be nurses. One of those students was me.

Sheila passed away on October 7, 2009. She was at home, in her own bed, at peace, and in no pain. Both of her daughters were at her bedside. She leaves a large nursing legacy--hundreds of students who will remember every word she taught as they use the information she imparted every day in their careers as nurses. They will remember the contagious and boundless enthusiasm and joy she found in all aspects of nursing: caring, learning, teaching, innovating. They will remember a woman who had an almost unlimited knowledge of nursing, who pushed and encouraged them to succeed at their careers in nursing for years after they left the school.

I'll remember her as Mom.

Bleh.

2009-09-13T10:54:00.004-04:00

Sorry I've been gone so long. It's likely I'll be gone even longer, because these days I don't have the energy or gumption to post.

I'm in school full-time, scrambling to finish my BSN. Work has been really, really bad lately--so bad that management has had to come in to do patient care because we're so busy and so short staffed--and it's not even cold and flu season yet!

And, on top of that, my mom, who has been fighting stage IV colon cancer with metastases to the liver (and probably lungs at this point) has taken a turn for the worse. She decided to stop chemotherapy after the last round was completed, saying at this point she's more afraid of the chemo than she is of dying. She did OK for a while, but now is deteriorating rapidly. She's got ascites and her legs are swollen; she's not eating much, and has lost so much weight that she looks like a pregnant skeleton wearing Uggs boots. She's not yellow...yet. She's not having trouble breathing...yet. But she's very tired, and sleeps most of the time, and doesn't have the energy to do much.

What's even more awful about this is that, as some of you may remember, my mom is a nurse, too, and is aware of exactly what's going on with her disease and body. She is also a terrible patient. (For a long while she was hiding how bad she was doing from me--my sister came for a visit and told me mom's legs were swollen. She always wore long skirts and dresses in front of me so I couldn't see how bad they were. When I confronted her, she said, "I was hoping you wouldn't notice.") It's pretty unfun. I know she's feeling pretty bad because when I tentatively brought up the topic of hospice ("you know, mom, for later, just so we can have some resources in place eventually") she immediately agreed and wanted it set up right away. She also gave all control of her finances to my sister, which is a HUGE thing for my mom--and she did it without so much as a blink.

So we had a meeting with the home hospice nurse yesterday, and I have to say that MAN is that program fantastic. My mom is going to get everything she needs, right at home--and if there's something she needs that can't be done at home (palliative paracentesis, for example), they get her a bed in an inpatient hospice for a few days and then it's right back home. No ED visit, no fear that she'll be admitted to a regular hospital.

Even with hospice in place, the next month or so is going to be pretty bad. Every time I go to visit her, I'm so afraid that I'll find her in her bed, gone. Part of me, though, hopes for that--that it will all be over, quick. The rest of me knows that this might end up being a long, sad haul for all of us.

I'm just so relieved to have a nurse who is experienced in these matters on the case. She has the knowledge to be able to tell me what's going on and maybe even what to expect, which is something I need--because my sister lives 500 miles away and is pregnant, and requires extra planning to get her here to say goodbye...eventually.

Ugh, this sucks.

Overheard in Triage

2009-08-16T02:00:00.000-04:00

Man: Do you have a CAT scan machine here?

Me: (stares at man)

Man: Seriously. Do you have a CAT scan machine?

Me: Yes, sir, this is a modern urban hospital. We have a CT scanner here.

Man: OK. How do I get one?

Me: A doctor has to order the test.

Man: Oh. So I can't just sign up for one?

Me: No.

Man: Are they expensive?

Me: They're not cheap. Do you have any medical problems that you'd like to discuss?

Man: No. I just wanted to see what my brain looks like. Thanks anyway! (gets up and leaves)

Thanks, Nurse Jackie

2009-08-15T12:08:00.002-04:00

There's been a lot of...well, not "furor," mostly just talk... about Showtime's series Nurse Jackie. Blah blah blah, not a good example of a nurse, blah blah blah detrimental to the public image of nursing...blah blah blah.

I've only seen the first episode (I don't have Showtime, and am waiting to Netflix the whole season to watch all at once), but I can't say anything bad about it.

However, I've become a huge fan of the show because of its effects on patients and their families in the ED.

Yesterday, a very difficult patient was about to go upstairs to her room. For her whole stay, she had been complaining and needy and angry. Just before she was to be transported, she started demanding her Valium. The admitting doc hadn't put in any orders yet. I told her so, adding, "I can't get the pills out of the machine without an order from the doctor."

She smiled. "Oh, I understand. You guys have a Pyxis! Don't worry about it," she said knowingly, "I watch Nurse Jackie!"

Finally, an apology!

2009-08-14T10:43:00.003-04:00

(Unfortunately, it was completely unnecessary, but whatever, I'll take it...)

We had a middle-aged guy come in with severe scrotal swelling and pain--it was so bad that he couldn't walk or even close his legs. If anyone even came near him, he would start crying and screaming "please don't touch me! Please!" He was a diabetic and on dialysis. And unfortunately, there was a really specific smell coming from his area--probably Fournier's gangrene.

I gave him a ton of pain meds but nothing was even touching his pain, and we needed to do a CT of his pelvis to see how bad it was--and to examine him. So the docs decided to do a sort of conscious sedation with ketamine. I've used ketamine on kids with no problem, but sometimes adults have an "emergence reaction" when it's wearing off--they can hallucinate and get a little nutso, so they have to be watched very closely.

I got him to the CT scanner on a portable monitor, gave him the meds, and we got the scan. Everything went well (except for the fact that the CT and manual exam pretty much confirmed gangrene).

When he started to wake up, he was relatively calm; a little moaning, a little thrashing, but mostly ok. When he was a little more awake, he kept looking at me and saying, "Miss? I'm so sorry, I'm so sorry!" I would ask him what for and he would say, "I didn't do anything nasty to you did I? I'm so sorry! Tell me if I did! Tell me the truth! I'm sorry, I didn't mean it..." I kept reassuring him that all was well.

Hours later when he was pretty back to normal, I went in to see him and asked how he was feeling. He told me he didn't really like the drugs we gave him. "They gave me weird dreams," he said. "Really?" I said.

"Yes," he replied, blushing and averting his eyes. I wonder what he dreamed?

Conversation of the Night

2009-08-12T01:15:00.000-04:00

Man: My grandmother is very sick! She needs antibiotics!

Me: Yes, the doctor just ordered them, and I'm going to go get them right now.

Man: But she's having cardiac arrest over there! (gesturing to his little grandma who is sitting up in the bed, smiling and eating a tuna sandwich)

Me: Do you know what that means?

Man: Uh, no. It just sounded important.

You're kidding, right?

2009-08-11T10:42:00.001-04:00

I was explaining my shift to one of the new attendings the other day. I work 11:30 AM to midnight. When I get on, I take other nurses' areas so they can go eat lunch. Then I go eat my lunch. Then I come back, and either give other nurses their 30-minute afternoon breaks, or I take an area from a nurse who is scheduled to leave at 4 pm. We've been very short-staffed lately, so often I'm in charge, doing ambulance triage, and, occasionally, manning the trauma room. Sometimes we have to close an area until 4 pm, because I can't staff it until I've given people their breaks. This attending said, "They should just open the area, and the nurses should go without their breaks. Us attendings don't get breaks when it's busy like this."

Them's fightin' words.

Nurses need breaks. Our attendings sit at a desk all shift long, occasionally getting up to see a patient (depending on what their shift is that day, teaching or nonteaching). Nurses are at the bedside. We clean butts, we move 300-pound patients with little or no help, we run around giving meds and assessing and even getting pillows and blankets in our CITY BLOCK LONG ED. We assist docs with procedures. We're the first line of defense when a patient's angry relative wants to know why they're waiting so long for care. Yes, sometimes patients and their relatives will ask at the doctors' desk when they're going to be seen--but that's a FRACTION of the complaints nurses field. A doc sees a patient for ten minutes and then writes orders that will take the nurse hours to complete: blood draws, blood cultures, IV access, Foley catheters, multiple meds, tests, monitors...and on a busy day when we're understaffed multiply that by EIGHT TO TWELVE patients. In addition to this, you need to factor in the admitted patients who need care: the doc's job is over with them, but they're still my responsibility to care for until they get upstairs, and I have to look them over and document and PHOTOGRAPH every dimple and freckle they might have, because god forbid it's a decubitus ulcer. They get to go pee once in a while. We don't. They get to eat and drink at their desk. We don't. They get to sit. We don't.

That's why we get breaks.

You know you're understaffed when

2009-08-10T21:36:00.002-04:00

Management calls and leaves a message BEGGING you to come in "for any part of tonight at all...any part...a few hours, that's all...please...I'll make any deal you want: All your weekends off next month? Anything! Call me please..."

I'd consider it, but I just worked five out of the last 6 days--all 12-hour shifts. I'm beat, and I'm already ensconced on the couch with a beer, Star Wars Robot Chicken on DVD, and my knitting. I'm not getting up.

Ambulance Triage

2009-08-08T12:07:00.004-04:00

These days it seems as if ambulance triage and walk-in triage is all I
do. Usually I would complain, but lately I'm so disgruntled with
management and the constant understaffing (8 nurses when we're
supposed to have 15), that I don't even care. And sometimes it's nice
to not have to make a commitment to a patient. "What's wrong with you?
Ok, bed 12. See ya!"

I LOVE

2009-07-27T08:15:00.001-04:00

Working three 12-hour shifts in a row, getting home at 1 AM, dragging
my ass out of bed to make it to my 7:30 am PALS recertification...

And waiting outside the locked classroom door for 40 minutes. Man,
this class better not be cancelled.

Pet Peeves

2009-07-24T23:35:00.001-04:00

I really hate when I'm in triage trying to talk to a patient, when not only is the patient's relative is refusing to let the patient speak for herself but is also loudly shoving potato chips in her maw as fast as she can. And talking on the phone.

Another triage pet peeve is when people walk into the booth when I'm trying to triage someone and keep interrupting me. Like when the PA from fast track wants Motrin from my cabinet or wants me to put my code in the glucometer, and the fact that I'm inspecting a boil on someone's posterior be damned. Or worse, when my loud boss comes in and starts yammering at me about some kind of administrative crap. Or a tech stands outside the door and bitches loudly about her assignment. It's really disrespectful to the patient and it distracts them and makes the triage take longer.

What are some of you pet peeves?

Different Species, Same Crap

2009-07-15T14:38:00.003-04:00

I had to take our dogs to the vet today--the little girl had some kind of eruption on her snout, like blisters or pustules, and it was very swollen; and the big old guy needed some tranquilizers because he's completely out of control during thunderstorms now.

So anyway, I'm sitting there, waiting to be called for my appointment, when an entire family walks in (all adults, no small kids) with their cat in a box. "What's the problem," the tech asks. "We need the doctor to look at our cat," the family says. "Have you ever been here before? Do you have an appointment?" asks the tech. No, and no, replies the family. What's wrong with the cat? Oh, it's not moving. At all. How old is it? There's some disagreement among the family members at this point; the cat is somewhere between 16 and 20 years old.

"Is it dead?" the tech asks. Nope, still breathing, but faintly.

They take the cat and family into a room where the vet, who is frantically racing around, pops in to look at the cat. I can hear him talking to them: "This cat is very weak and dehydrated; to save her life we would need to give her fluids and medicine and she would need to stay in the hospital for a few days. It would cost a lot. She's very very old, so perhaps your family should discuss what you think you'd like to do."

The family began to ask some questions: Yes, a hospital stay for a sick cat is pretty expensive. No, the vet doesn't take medicaid. Yes, the kitty is pretty far gone, maybe a day or so ago we could have caught the dehydration, but now it's kind of late.

Meanwhile, out in the waiting room, an elderly Russian lady who speaks almost no English is trying to establish whether the vet is old and Jewish, because god forbid a young goyisha maidel like the old Jewish vet's partner should care for her...what? She says a word in Russian over and over; it sounds like "ploofa." Finally she flaps her hands. A BIRD! Oh, and this Jewish vet, can he make a house call this Saturday? Because the birdcage is too big to carry. Also, the bird talks and sings. It's very nice bird! Can she please speak with the vet right now about it?

It was a very amusing visit. It felt like being at work, except that I wasn't! So we saw the vet and left with some clindamycin for the girl and some doggie thorazine for the boy. Thunder's a-rollin' in tonight...hope it works!

Summer...

2009-07-14T00:08:00.003-04:00

I'm back from South America and enjoying the more temperate weather up here...winter in Buenos Aires is pretty cold!

I'll be posting soon...just enjoying not being ticked off right now!

Cafe con leche in the jungle

2009-06-28T09:17:00.000-04:00

In Puerto Iguazu, Argentina...

Update

2009-06-19T11:13:00.003-04:00

Sorry I've been so bad about posting lately...work has been so busy and nuts that I don't want to think about it, let alone write about it when I'm not there!

Apparently I'm in a spot of trouble because a patient (who happened to be a retired nursing supervisor) sent in a complaint letter about me, saying how unpleasant and unprofessional I was when taking care of her. It's a long story, and I actually only had a three-minute interaction with this person, but what the letter didn't happen to mention was that this patient actually HIT ME during the course of our time together. The "powers that be" want to have a meeting with me to discuss "my attitude." I wrote out my side of the story, and I told our associate director of nursing (who is on my side, by the way) that if they want to have a meeting about this, I'll bring my union rep and a police officer to take my statement as I file assault and battery charges against this patient. This was not some gorked-out old lady who is demented and has no idea what's going on. This was a 62-year-old woman with back pain. I'm sorry, but no matter how much pain you are in, it's not OK to hit the person who is attempting to help you get to a bed.

Thank goodness I'm on vacation for two weeks. Argentina, here I come!

Ambulance ≠ Free Pass to the Front of the Line

2009-05-28T12:49:00.002-04:00

No matter what you think, coming to the ED in an ambulance does not mean that you get to STAY in the ED and not go outside to register and wait your turn.

The ambulance is not a taxi.

The ambulance is not a free pass.

Just because you picked up the phone and called 911 and they came and got you and they brought you to the ED does not mean that you are having an emergency.

Who decides if you're having an emergency? That's right. ME.

Just because you were here two days ago for your 99-degree fever and slight cough does not mean that you get to be ahead of all the people with 101 fevers and coughs who have been waiting three hours to be seen. You're no sicker now than you were then.

Lying down on the floor (EW! do you KNOW what has been on the floor before you lay there?) is NOT going to get you my sympathy. In fact, what it will get is a doctor hovering over you, telling you to get up, you're fine, and then two security guards to escort you to the waiting room.

My Butt-Clenching Moment

2009-05-23T20:56:00.005-04:00

So there was this really sick dude, right? All intubated up and stuff? And he's like on pressors and jazz? And he's like lying there in the bed. And then he starts throwing frequent big ol' PVCs. And then a few runs of V-tach. So I mosey on over there and put the defibrillator pads on him--just in case. He seems fine for a few minutes, and I go back to my seat.

The ICU doc covering this patient calls me and says, "Can you start a magnesium drip on this guy? His magnesium is really low." So I start the drip, but am running it a little slow, because his pressure is pretty low and I don't want to drop it too bad. I'm sitting back at the desk and I happen to glance over at the monitor and what to my wondering eyes should appear:

I LEAP up, run to the bedside, yelling for a little assistance, check and--no pulse. Then, without even thinking about it, I charge the defibrillator and shock the guy. It was like my hand just flew out there and did it by itself. By the time one of the docs got to me, the guy was back in NSR. The doc said, "Well, looks like you've got this under control. Good job!"

And then I sucked in a big breath because I realized I hadn't been breathing for a little bit there, and then I turned up the magnesium drip a little.

The swine flu is kicking my ass

2009-05-19T14:01:00.003-04:00

No, I don't HAVE the swine flu. But dealing with all the people who think they do is really getting on my nerves.

We had a very well-publicized death from the swine flu in our area recently (THANKS MEDIA!!), and yesterday had a huge upswing in visits from people "who need to get checked out."

I've had to explain eight gazillion times that:

-We don't swab for ANY flu if the patient is not sick enough to be hospitalized.
-If you don't have any symptoms, we can't "check you" for the flu.
-A slight cough, low-grade fever, and some body aches is not enough to get you hospitalized if you are a generally healthy person.

PLEASE TAKE OFF THE FREAKING MASKS ALREADY IF YOU ARE NOT SICK!!!! What I especially love is all the people walking around with the masks slung around their necks. The whole hospital looks like our surgery floor. Oh, and PLEASE stop asking for gloves. Just go wash your hands or use some hand sanitizer.

The most amusing episode in all of this was last night. The "asthma" area was full of wheezing people, thanks to our record-high pollen levels and fluctuating weather patterns. Two young women sit next to each other: an African-American girl and a white, Eastern European girl. The African-American girl is wheezing, coughing, feverish, has an obvious runny nose and looks unwell. The Eastern European girl has a low-grade fever with slight abdominal pain and vomited once.

One of my least favorite doctors swooped in and moved the Eastern European girl off to a bed, complete with mask on "because this might be the real deal." Uh huh. On further investigation, the African-American girl? Lives at the epicenter of all of the swine flu madness, and everyone in her family is sick. If you ask me, THIS lady is the one in contention for "the real deal." I found a spot for her to lie down and gave her a mask. She got admitted, and the swab was pending when I left to go home last night.

I can't shake my feeling that the doc moved the Eastern European patient to a bed because she bore a strong resemblance to his wife.

Another study in contrasts

2009-05-19T13:55:00.002-04:00

I just don't understand why people don't medicate their kids. Your two-year-old has a 105 fever? For two days? What, no Tylenol or Motrin? Oh, I see, you were waiting to see what we say is OK to give to your kid. No call to the pediatrician, huh? Oh, ok. What's that? Your four-year-old fell down and hurt his arm two days ago? And it still hurts? Did you give any Motrin? Oh, I see--you brought him in last night, but you had to wait more than a half hour, so you changed your mind? Ok, so you brought the poor kid home and dragged him back here this morning and HE IS IN PAIN AND YOU NEVER MEDICATED HIM???

Contrast this to the woman who came in with dental pain after an extraction who has been taking SIX tylenol. Every TWO HOURS. Around the CLOCK. FOR THE LAST TWO DAYS. Oh, and now your stomach really hurts? I bet it does.

Ma'am, you now have much worse problems than your dental pain.

And in THIS corner...

2009-05-14T12:34:00.003-04:00

Seems like I've been fighting with patients a lot lately, and getting my butt kicked by little old men and women.

I have some lovely deep scratches on my right forearm from an elderly woman who really didn't want me to draw her blood.

And I have two (count 'em) hand injuries resulting in swelling, both from little old dudes who didn't like me much. One took my right hand in a gentle, caressing way and then proceeded to look me in the eye and twist my index and middle fingers so hard that both proximal knuckles popped and swelled up significantly. The other old dude grabbed my left thumb as I was trying to clean the poop off his hands and bent it all the way back, laughing maniacally. I'm very grateful that his family was not there at the time, as I yelled, "OW! You FUCKER!" at him. It was the end of the night and I was tired of getting beat up.

Also I caught my psych patient (with a blood glucose of 600) squeezing her urostomy bag so hard it squirted piss all over the curtain and floor in a lovely golden fountain. When asked why she was doing it, she said, "No one brought me a sandwich!!" I asked her if she had requested a sandwich. "No, but NO ONE BROUGHT ME ONE AND I AM HUNGRY!!!" So apparently my mind-reading abilities are off, as well.

How to Get Swine Flu

2009-05-01T13:00:00.002-04:00

F*&%ng SWINE FLU!

2009-04-30T11:39:00.002-04:00

What kind of country of dummies have we become when the PRESIDENT has to go on TV and tell us to WASH OUR HANDS and COVER OUR MOUTHS when we cough?

Triage has become a nightmare now what with all this "Swine flu" nonsense. I live in one of the cities where there was a cluster of infections, and our hospital has gone into full panic mode. There are masks at every entrance with signs saying "If you have a cough or fever, please wear one." So, since they're free, everyone has two or three on them, even the kids. I'm constantly stopping people and asking if they have cough or fever. No? TAKE THE MASK OFF, FOR GOD'S SAKES!!! You're just here to visit grandma!

Also, for every actually sick person I triage, I get two or three who are just worried about the swine flu. These are people who won't bother to get a regular flu shot--and the regular flu can kill you too, you dummies! Some questions:

Pt (on the phone): I need my family to get tested for swine flu. We just got back from Mexico.
Me: Are any of you feeling sick?
Pt: No.
Me: No coughs, no sore throat, no fever?
Pt: No. But I have two kids who have to go back to school.
Me: ARE THEY SICK IN ANY WAY?
Pt: No.
Me: I suggest you stay home.

Other pt (in triage): I have flu symptoms. I think it's the swine flu.
Me: Were you in Mexico?
Pt: No.
Me: Were you around an infected person?
Pt: No.
Me: Then you probably don't have the swine flu.
Pt: How do you know?
Me: Because you weren't exposed to it.
Pt: But I feel sick.
Me: You are sick. You just don't have the swine flu.

Please note that on top of all of this, I'M SICK. I have some upper-respiratory thing, brought on by the insane amount of pollen flying around. It started with a sore throat and uvula that was so swollen, I actually went in to my own ED and got one of the docs to give me a shot of Decadron so I could breathe and swallow. That thing was like a freaking THUMB dangling in the back of my throat. Then it progressed to a hacking, mucus-filled cough that burns my chest. Guess what I'm doing? STAYING HOME.

Featured on an AJN Nurse Blog

2009-04-24T21:40:00.002-04:00

Sylvia, another nurse blogger mentioned me in her blog in a post about RNs who have other talents. Check it out!

Thanks, Sylvia!

Uh...ok

2009-04-23T10:42:00.004-04:00

Sorry I've been gone so long! Things have been very busy, what with work and school and the band being in the studio.

I've got nothing about work to relate, but this happened last night and it was too good not to post.

I was on our lovely mass transit system last night on the way home from work at about 12:30 AM and on sitting down in my seat, this is what I saw directly across from me:
What is that, you ask? A well-dressed man with a pair of grey men's briefs plastered to his face, poking the fabric up into his nose with his fingers. Thanks, iPhone, for letting me snap this pic super fast!

What happened next, you ask? He put the underpants away in his shopping bag, and pulled out a plastic bottle full of some amber liquid, took the top off, and proceeded to sniff the contents. I don't believe that it was apple juice in that bottle.

I LOVE living in this city.

Can it be?

2009-04-06T11:59:00.003-04:00

Are things maybe getting better where I work?

We had a good weekend. Not too crazy, not so slow that time drags: enough time to actually take care of patients, to get to know them and talk to them and be pleasant, instead of running around like crazy, flinging medications and treatments at them. I really feel as if I made people feel better. (Corny, I know!)

And the icing on the cake for me was when a woman approached me and said, "You probably don't remember me, but you saved my life." It took a second, but I did recognize her. She had come in with excruciating abdominal pain with referred pain to her shoulder, having syncopized--her blood pressure was 75/40 and she was pale. Yup, ruptured ectopic. We got her up to the OR in about 18 minutes flat, emergent transfusion running all the while. I actually recognized her husband first; he had been so worried about her, was crying, and wouldn't leave her side. They both told me that I made them feel so safe, that everything was going to be OK. And everything did turn out to be all right (whew)!

It was really, really nice to hear. Ok, I'm happy to be a nurse again.

Sorry, nice man...

2009-03-23T11:11:00.003-04:00

But I couldn't handle you being nice to me the other day.

I was running around like a crazy person on a night when we were packed to the rafters. I was supposed to have the "easy" area, the one including the asthma chairs. But there were people with abscesses, and possible DVTs, and pneumonia in there. And because we were working short, I had several other rooms. And because one of those rooms was a monitored room, I got an ICU patient who needed CVP monitoring. I also had two psych patients who could barely keep from fighting with each other. People were (justifiably) bitching about their long waits, and for some reason, they all kept asking ME (instead of their own doctor or nurse) about when they would be seen, and could they have a sandwich, blah blah blah. One man was rummaging around in a cabinet, and when I asked him if I could help him, he said he wanted a straw (a hot commodity in our ED) for his wife, who was in another nurse's area. I went back into our staff lounge and dug one up and then ran off on my busy way.

The patients kept coming, my CVP guy was becoming increasingly more unstable, and I was feeling incredibly overwhelmed, being buttonholed by docs every other minute about orders for their patients, and feeling unable to keep up with everything I had to do.

I was standing at my desk putting together an IV setup when the gentleman for whom I had found the straw came over. He looked me in the eye and said, "You know, I've been watching you. Everyone around here looks busy, but you're the only one who is actually DOING something."

I stared at him for a second and said, "Well, thank you, that's very nice to say."

He touched my hand and said, "I really mean it."

My eyes immediately began to well up with tears, and rather than completely lose it, I snatched my had away, averted my eyes, mumbled, "thanks," and sped away, so he wouldn't see me get upset. I feel really bad about blowing him off, but I couldn't take it.

So, thanks, nice man, for nursing the nurse.

I'm snippy!

2009-03-13T12:27:00.002-04:00

Apparently.

We had a very busy evening last night. People were being packed in like sardines, many were very sick, and there were people waiting outside for hours upon hours. I had EIGHT SKIJILLION patients.

And then the husband of one of them comes over and says, "Excuse me, I don't think it's right."

"What's not right sir?"

"My wife has to share a spot with some other lady, and I don't think it's right. She needs to be moved to another room."

I blinked at him. All around, people were in stretchers in the hallway, doctors rushing around, the asthma chair area was packed with people in seats we had dragged in from the waiting room, alarm bells going off. It was chaos. The man's wife was in a room with a little old lady who had been moaning in pain, but who had stopped and drifted to sleep after I gave her some medication. No stinky wounds, no poop dripping on the floor, no urine-stained reeking bedclothes.

"Sir, it's very busy today, and unfortunately, the ambulances haven't stopped coming. There are quite a few people sharing their rooms. I'm sorry it's that way, but it has to be like this for now."

"We pay good money to this hospital, and I think she should have her own room."

"I do too, but right now it's not possible. I'm sorry."

He huffed away. The woman's roommate was pulled out of the room for a CT scan, and when she returned, the transport tech notified me that he couldn't get the stretcher back in the room. I went over to see what was wrong. The husband had moved his wife's stretcher to the middle of the spot, and had barricaded them in with three chairs piled high with her stuff.

"I'm sorry, we have to move you folks over a little bit, and remove some of these chairs so this lady can come back to her spot," I said as sweetly as I could.

"But she left! This is our spot now!"

I took a deep breath. "Listen to me. I have explained to you that for now, you will have to share a place with this woman. It is not acceptable to block the space with your things or to move the bed over. Please let me move it back."

Of course, now the inevitable: "I think you have a bad attitude, Nurse. Who is your supervisor? I need to speak with your supervisor." I wearily pointed him out, about 20 feet away, amusedly watching the situation.

Of course, he got an earful. Later our manager came up to me and said, winking, "You know, apparently you're snippy! I'm going to have to put that in your permanent record!"

Overheard in the ER

2009-03-04T13:05:00.003-05:00

A 60-year-old grandpa singing "Always and Forever" to his little 5-month-old baby granddaughter who was visiting him. I don't think there was a dry eye in the house.

Here's a reminder:

IF...

2009-02-28T00:21:00.001-05:00

You are going to come to the ED for some nebulous complaint, AND you are going to tell people that you, yourself, are a physician...

it behooves you to at least know A LITTLE something about medicine and such.

For example:
- a blood glucose of 137 mg/dL is NOT "abysmal."
- a pulse rate of 96 is NOT tachycardia.
- that nice, even, regular wave on the monitor and on the EKG is NOT "a tachydisrhythmia."

If you're going to pretend to be a medical professional, it might help to actually know some stuff. Because we actually do know some stuff, and now we just think you're weird.

P.S. Hi Stacy!
P.P.S. This post wasn't about you. I was just saying Hi!

People are kind of inconsiderate

2009-02-25T17:42:00.002-05:00

You'd think I'd be aware of this by now.

Our ED has only seven rooms with walls; the rest are separated by curtains. This isn't the best for privacy. Especially when you're changing a colostomy bag.

This poor young man came in with a possible infection to his new stoma. There was some gross drainage, in addition to the very stinky poop that was coming out of it. His mother had gotten the wrong colostomy bags by mistake, so it was ill-fitting and leaking on his skin and clothing. He was miserable, feverish, and very upset about the odor emanating from him.

I went in with a basin, cleaning supplies, gown, and a new stoma dressing/kit and tried to fix him up, a process taking considerable time and which released a lot of stink. But we kept at it, and eventually he was clean and feeling better, no thanks to the people next door.

The entire time we were getting cleaned up, all this poor kid could hear were comments like "Dang, something smells like ass in here...why don't they spray some spray around here, this shit is NASTY! This shit gonna make me puke! You got any perfume, cause some shit up and DIED!"

I left the area to dump all the soiled material in the dirty utility room, and they all yelled after me, "Miss! What stinks? Can't you clean up this stink?!? Get some spray! This shit stinks!" I hushed them, and said, "It will be better in a minute, please, keep your voices down."

The poor kid with the stoma was just about in tears. He kept apologizing. I told him he wasn't the one who needed to apologize, that ER's are full of bad smells, and that's just the way it goes. I also told him that he'd learn how to deal with his stoma, and soon it wouldn't be so bad. My heart was just about breaking for him.

I know the people next door didn't know what was going on, but seriously. It's a hospital. Sickness smells bad. Deal with it.

Deeeeeep breath...

2009-02-25T17:39:00.002-05:00

My dreaded statistics course is done. I finished my final project (Tuberculosis stats, anyone?) and am now waiting for my final grade. Honestly, I don't care what it is as long as I pass. I'm just so relieved that this is over.

I talked myself out of doubling up classes for this semester. I'm only taking one: Medical Ethics. I can see now that I have room to raise my head and look around. And now I'm seeing all the crap I haven't done for the last three months. Like laundry, and putting up some shelves in the living room.

Here I come!!!

They're Everywhere!

2009-02-22T20:51:00.001-05:00

Self-important jerks, that is.

Look, dude. I know you want your daughter's amoxicillin, but yelling "IT'S JUST AMOXICILLIN! Why can't you do it NOW" at the poor lady behind the pharmacy counter is not going to get it to you faster. Does it even occur to you that there are people ahead of you who are calmly waiting to get their prescriptions filled and who are not attempting to jump the line just because they think THEIR prescriptions should be filled faster?

Also, just because the ED waiting room only has about six people in it does not mean that it's not a crazyevening in the actual emergency room. Rolling your eyes at me and saying, "You call THIS busy?" is not going to endear you to me, either.