Monday, June 29, 2015

Up next...

Recently I took a vacation up to Oregon, and had an absolute blast. Everything was beautiful - the hikes, the mountains, everything. Even the lawn at a coffee shop was exquisite. And THE BEER. So much beer. I came back from that vacation and called my recruiter the next day to tell him I wanted to go back.

I'm super excited to say that starting early August, I have a contract in Central Oregon! It's going to be a tiny little ER in a tiny little town, and I am so thrilled to be able to get back up that way.

If you had any doubt as to the beauty of this area, and were wondering why I want to go back for a bit, here's my proof:


So much excitement!

Monday, June 22, 2015

Foot in mouth

Oh man. After all these years, my brain-to-mouth filter finally shit the bed at the most inopportune time. A couple of us were taking care of this critically ill dude in respiratory distress, and having a tough time of it. Everything that could go wrong at first was - the EMS initiated IV line blew while the mag was infusing, I had to drag in the sono-site for another line because he had shitforveins, and the horde of residents were generally the worst.

We were trying to get an EKG after they had refused to let us give even the tiniest bit of ativan to ease the stress of BiPAP, and it was going about as well as one can guess. Meaning it wasn't going at all. We're struggling to keep the guy from anxiously moving and pulling his mask and leads off, and he just can't sit still. This continues for at least five minutes. We get a sort-of okay EKG and hand it over to the resident. He glances at it and announces to the entire room that "this EKG is terrible, you all need to get a better one. Or go get someone who can."

Of course, of course, I'm the most senior nurse in the room. The other two nurses with me are super intelligent and great nurses, but they're still new. And nice. So they say nothing. And of course, of course, I'm also the biggest dick in the room because I mutter, "you can see that we're obviously doing our best with this guy, but please, continue to stand there and criticize without doing anything. Or fuck off, which would actually be more helpful."

I'm not sure if the patient heard me or was able to comprehend anything. But the rest of the room sure as shit heard it. I did see one of the other residents trying to hold back a laugh, and both of the nurses had looks of either horror or awe on their faces, but I'm wondering if this will earn me a write up. The EKG resident didn't say anything, but he didn't stick around for long after that. We got the guy up to the ICU shortly thereafter anyway.

Ugh. I get that you can't read an EKG full of artifact, but I also can't magically pull a beautiful tracing out of my ass when the guy is too sick to sit still or comprehend why we're telling him to. But whatever. I'm not sorry.

Tuesday, June 2, 2015

Good service goes a long way

I do so love patients with a sense of humor. Recently I've had a run of hilarious people seemingly oblivious to their injuries and more interested in making the staff laugh than in feeling sorry for themselves.

The best patient of one of these nights was a simple fingertip amputation - she got it caught in some sort of fancy kitchen tool and took the distal two centimeters cleanly off. I guess she was in the restaurant business because after being told she was going to permanently lose the end of her finger, she forlornly looked over at the fingertip laying on the suture tray and offhandedly said to the ER doc, "I think this is the worst tip I've ever given in my life! I knew I shouldn't have left my wallet home..."

Saturday, May 2, 2015

Dissatisfaction

I think one of the reasons I don't like working at this current facility is that it doesn't challenge me as a nurse. I take care of the usual things like MIs, CVAs, abdominal pains, and headaches. Standards of care are pretty even across the board and I know what to do from start to finish. Occasionally there is a more complicated patient, but those are the exception and pretty infrequent at that. We do see a large specific population of very sick people, but they are so tightly managed by the inpatient team that there is little to do for them in the ER. I'm getting to the point where I feel as if a lot of my critical thinking and ER-specific skills are going by the wayside.

The point where I definitively realized this was sitting in PALS recert class the other day. The instructor asked a question and I had no clue as to the answer. I used to know it. I used to deal with peds all the time. I used to know those critical weight-based dosages for cardiac meds because I gave them regularly. But somehow now I don't.

I haven't taken care of an actual sick kid in what, eight months? It's kind of scary. I immediately went home and started reading up on peds again because I don't want to be that person who gets complacent on nursing knowledge. Though the fear of accidentally killing a patient is much less pronounced these days, it's still there. And by letting my skills and knowledge base slide is a great way to fuck up and let that deepest fear come to pass.

This facility is mostly nice, the people are nice, and it's super amazing to have a real lunch break all the time or get chances to go pee or sit on my butt with only two patients for three hours because it's a slow day...but if those nice things are at the expense of me progressing in my career, then I don't want to be a part of that hospital.

Friday, April 24, 2015

Wit

Recently I took care of an absolutely ancient woman who was sharper than I am on any given day (no matter how much coffee I drink). She was hilarious, witty, and pretty much the embodiment of everything I want to be as a cantankerous old lady. She also had a daughter present who was up there in years but wasn't mentally aging nearly as well as the old lady.

The daughter spent a large portion of the ER visit asking the staff questions for which she was unable to comprehend the answers to, trying to figure out the desk phone to set up a ride home, getting lost in the ER while trying to find the bathroom directly across the hall, and stopping any wandering resident she saw to warn them about spending too much time in the hospital away from their families. It was clear the patient was trying to rein her in, but as the patient was ancient and not very mobile it wasn't working too well.

At one point the daughter comes out to the desk and is sort of conversing with myself and another nurse. It was a very circuitous and slightly frustrating discussion, but we were trying hard to help the lady out. Suddenly we hear the callbell phone start dinging, and the other nurse picks up the phone at the desk. On the other end, as she told me later, she hears this: "Is my kid bothering you again? Tell her to shut her damn mouth and leave y'all alone! Get her on in here, I need my foot rubbed!"

The patient stayed on the phone until she heard her daughter shuffling back to the room, and then goes "you're welcome!" and hung up the callbell phone.

I love crotchety old people.

Saturday, April 18, 2015

Feelings

While discussing general ER happenings with a friend, we got onto the topic of cancer and people being dicks. I'll be completely honest - having cancer is like a get out of jail free card with me. One can pretty much be the meanest person ever but I'll be like, eh, not mad because cancer sucks and I'd be hateful too probably.

But a few weeks ago I had a patient who was just the absolute worst - he had some serious cancer issues going on but signed out AMA from the ER almost immediately. As is his right, but when I asked him to sign the forms, he said "I'm not signing anything for you, you cunt." And walked out.

So when I saw that he was back in the ER the other day and trying to sign out AMA again, I just kinda shook my head. I know cancer sucks - really, it does - but I found I had zero sympathy for the dude. He's gonna die, and probably soon, and I didn't care at all what happened to him.

Does this make me a mean person? Or am I right to not care about someone after they were genuinely horrible to me? I don't know how to feel about it - on the one hand, I get that cancer is awful and I can't expect someone to have the warm fuzzies towards everyone all the time, but on the other hand I can't easily forgive someone calling me awful names and being terrible just because they wanted to. I don't know. I feel guilty for not caring but at the same time I feel indignant because he was an absolute dick to me.

Feelings. I haz them, and they keep me up blogging at 0300. Ugh.

Friday, April 10, 2015

Bougie, but not the useful kind

It has become painfully clear that I am now working at a very upscale fancy-pants clinic, not a real ER. I suspected it from the start, when I was told that our focus is on providing a hotel-like experience and to make sure I kept my patients fluffed and fed and watered no matter what, and that actual nursing takes a backseat to keeping patients happy. I've stayed on because the pay is good and its a pretty easy job, but I'm getting to the point where the pros are so outweighed by the cons that my rage has escalated before I even pull up to the hospital.

I know that I go back and sing the praises of my home hospital probably more than necessary, but it's the truth - despite the little aggravations here and there, it was a top of the line well-oiled trauma/medical ER with smart providers, hardworking staff, and the ability to handle whatever was thrown at it. But my current place? No. Not even close.

The tipping point came the other day. We had an incident which brutally showcased just how fucked this hospital is when it tries to function as, you know, a real hospital instead of the bougie clinic they actually are. The breakdowns were evident from the moment the patient came in the door. Too few staff in triage, a poorly designed waiting room with no code button, security that not only didn't respond promptly but asked why the triage nurse couldn't just handle the extra people by himself, a lack of an easily accessible stretcher to get to the waiting room, doors that don't swing open automatically so it's near impossible to get a patient through without assistance, a surgeon who wanted to finish dictating a bunch of notes before coming to see a legit trauma patient, no ancillary staff to assist with a critical patient, a radiology department that isn't dedicated to the ER, radiology is constantly dealing with inpatients so they send transporters to pick up those patients which takes an obscene amount of time, refusing to clear an inpatient off the CT scan table until transport was present so we could pan scan the sick ER patient emergently, having a trauma cart but having it clearly designed by someone who has never worked in trauma so it doesn't actually have anything useful in it, and then not having ancef stocked in the ER pyxis so it instead takes forty five minutes from pharmacy. Among other things, but I think I make myself clear.

It's just the worst. I don't know how much longer I can work here, even though I like the people and the pay is very nice. I feel like this place keeps polishing their expensive turd so it shines radiantly  for the bigwigs, yet don't even realize it's not a good hospital - it is just a big old shit pile.

Wednesday, April 8, 2015

Encouragement

I had a very sweet old lady as a patient tonight. Mundane chief complaint, not a big deal, got discharged in a reasonable amount of time. Except that she didn't get discharged right away. I was busy, and in the room next to her was a patient who started his interaction with me by saing "you my nurse? Go get me some motherfucking juice" and ended his interaction screaming down the hallway that I was a bitch for not getting him four blankets instead of the three I did bring. There wasn't much interaction after that because I called security after telling him I would no longer be taking care of him as I refused to cater to his ignorant behavior, and since he was incapable of treating me with respect I would not be coming into his room again. I let the charge nurse know, and she passed along that the patient had burned pretty much every bridge he had there which is why he was given to me in the first place - ah, the joys of being a traveler.

Anyway, that patient got escorted out by security and I went to discharge my sweet old lady. I apologized for the delay in getting her paperwork, and she cut me off mid-sentence to tell me that she appreciated all we did for her and to not worry about a thing. I thanked her and went to move along in the discharge lecture when she stopped me again. "No, honey, I don't think you really heard me," she said. "Thank you, for all that you do. It means the world to people like us. Don't listen to those assholes who don't treat you with respect. I see how hard you're working and you're doing a damn fine job of it. Keep it up."

I really needed to hear that today. It's just an extra bonus that her sailor mouth is worse than mine.

Sunday, April 5, 2015

Ridiculous

So, I had a seizure patient come in the other day who told us he was taking his keppra but missed a dose, or maybe he didn't, or he might have taken depakote instead because he had an old prescription, but really he can't remember at all. No big deal. I sent off a rainbow of blood to the lab and the doc ordered a keppra level.

Two hours later it still hadn't resulted, so I called the lab. "Oh, that's a send out," they said. "It's Friday night, so that probably won't get resulted until Sunday or so, but since it's a holiday it'll probably take longer."

Am I just spoiled from working at a fantastic Home Hospital? Even though we were somewhat rural, we had everything - neurosurgery, cath labs, primary stroke certification, and especially fucking keppra levels. I now work in a "state of the art" facility which apparently can't find their ass from a hole in the ground and get basic labs done in a timely manner. Or am I just asking too much, and keppra levels aren't the norm? Oh, and we do deal with neuro stuff, so I feel like being able to do standard neuro-related labwork shouldn't be this damn difficult.

Monday, March 16, 2015

Remembering

Back during the first couple years of my career, one of the most common summer injuries was of pedestrians struck by vehicles. Living by a resort town always saw some high school or college kid on vacation who thought they could run across the street before that next vehicle got to the intersection. For the record, the car wins every time. Always.

After time of death was announced on one of these kids, most everyone cleared out of the room. I had looked at the massive skull fractures on the CT scout image, and wanted to see for myself what that correlated to in a real person. So I walked up to the head of the bed and carefully stuck my finger into the gaping wound on this kids' scalp. The doctor walked over while I was doing this and pointed out smaller details that I hadn't yet noticed - how neatly the scalp separates from the skull, how jagged some edges can be while others are the cleanest of breaks. She walked out of the room, and I was left there with my finger still poking into the skull of a dead 17 year old.

I remember being so thrilled with the action of the trauma team, the organized chaos, the medical knowledge versus the brute force to deal with orthopedic trauma. I was still riding the high of this experience, and then all of a sudden I realized exactly what I was doing. I had my hand inside the scalp of a dead 17 year old. A kid on vacation with his friends. Someone only a few years younger than I was. I hadn't even closed his eyes after time of death was called.

That morning after I got off work, I cried the whole way home. How could I have been excited to do something like that? I never wanted to become so immune to the tragedy of the ER that I forgot I was dealing with real lives, real people.

Here I am six years after becoming a nurse. I look back at that day and wonder if I would have cried afterwards if the same scenario replayed tomorrow. Would I still be shocked at the moment I remembered there was a real person on that stretcher? Would I have forgotten it in the first place? Or would I just be excited for a complicated trauma, and never really stopped to think about it at all?

I've changed so much as a nurse. Much of it is for the positive - I'm smarter overall, more confident in my nursing, better able to handle high stress situations. I am way more skilled in the things JCHAO cares about and more solid at the clinical skills. Does this make me a better nurse? I don't know. I do know that I haven't cried on the way home in a long time, and I think that speaks volumes.

Tuesday, March 10, 2015

Tea and sympathy

Every now and then I get curious as to how people stumble upon this blog. Such was the case today when looking through the referral google searches and stuff.

Someone yesterday found it by typing "who else hates meditech."

Anonymous person, I feel your pain. I really do. And to answer your question, me. I hate meditech.

Press onward, stay strong, and pray that one day the hospitals advance to 2015 and dump meditech like it's yesterday's taco & elotes washed down with a pint of beer.

Monday, March 9, 2015

Gowns 2.0

We already know that people somehow forget how to use their brain and what sentences mean when they come into the ER. The most annoying example of this is when I ask someone to take off all of their clothing then put on a gown, and I come back three minutes later to find not only have they not taken off any their clothing but that somehow layers have been added prior to donning the gown. Seriously. People. Clothing off, gown on, in that order. It's not rocket science.

The flip side to this, however, happened to me the other night. I pulled the IV cart into the room to get things set up, and the patient hadn't changed into the gown yet. So while I'm getting IV stuff ready, I asked her to get undressed and turned around to give a smidgeon of privacy. It was really fucking cold here in Texas recently so the lady was buttoned up like a champ with extra layers on, mind you. I'm not turned around for more than fifteen seconds when she announces that she's all changed. I look back, and my god this woman has somehow managed find a space-time wormhole in which to get undressed, gowned, de-shoed, and covered back up in a blanket. She even folded her shirt and pants. Clearly she has no respect for the laws of physics because that process should have taken waaaay longer.

Again. I have no idea how on God's green earth she managed to get herself situated so quickly. Fifteen seconds. If I'm lying I'm dying. All I could think of was this:



Saturday, February 28, 2015

Temperature

During some downtime at work last night, a couple of us got into a discussion about the accuracy of the temporal artery thermometers. Opinion was pretty evenly split between us though so we decided to check our temps with both oral and TA thermometers.

The coworker who picked up the TA also decided to make everyone guess their own temps. When he got to himself, he scanned his forehead and goes "aha! Just like I guessed..."

Another nurse, who was just passing by, jumps in - "a hot mess." And kept walking. It was perfect.


Thursday, February 19, 2015

Cancer

Cancer sucks. I hate being in the room when the patient gets news that his recent metastases are growing exponentially. It's hard to look at his face when he realizes that his initial 18 month survival projection is far less than that now. It's even harder to look at the face of his wife. When they hold hands and he reassures her that he's just glad they'll make it to their 50th wedding anniversary later this month - and he's gonna go all out to make it their best one yet - I can't help but be angry, yet again, at cancer.

The patient looked over at me while I was setting up his PCA pump and asked if I was okay. How are you worried about me at this time? You're dying. You should be focusing all of your energy on yourself, your wife, your mortality. How can you still be so kind and thoughtful enough to make sure me, the nurse you've never met before three hours ago, is holding up?

The doctor asked a lot of questions, but the hardest one to hear is the DNR status. Sir, you're going to die. If you die today, what do you want us to do? Fight it? Let you go? How are you so calm about this? I'm angry for you. You shouldn't have to answer this question today. Why can't cancer have waited, or left you alone entirely? You should be on the golf course or out to dinner with your old lady, not confined to an uncomfortable ER bed with a nurse who is bitter on your behalf.

You and your wife had matching hair color. You were so proud of it, you tell me. It's gone now, and thanks a lot cancer. It takes everything, even the stupid stuff that it should ignore. Cancer sucks.

Tuesday, January 27, 2015

Gross

There are a lot of gross things about hospitals. They are inherently disgusting places, with the constant eau de C Diff wafting around, LOL flakies in the air filters, blood and vomit and other horrible secretions on the floor and stuck to the bottom of our shoes, and countless other things that we try to clean up but inevitably can't always get to. Seriously. They're the grossest place ever.

On a side note, few things sicken me more than watching an ER patient barefoot it across the room and down the hall into the bathroom. BARE FEET. On an ER floor. Oh, the humanity!

But for as gross as patients can be, there is one pet peeve of mine which always seems to happen and it in no way is the fault of the patient. One would think that the offenders would realize how effing disgusting this is, but it's happened in every single hospital I've ever worked in.


THIS. THIS IS GROSS. How can this keep happening?! I've watched a lot of terminal cleans, and I've never once seen environmental bleach wipe the O2 valve. Never. Ugh. It's so gross. That patient has been breathing and coughing and being generally phlegmmy all into and around this neb, and then you just put their used nasty humid...dare I say it...moist* neb tube all up on that valve. Ugh.

It's just so gross.

So gross that I had to use the grossest word of all time to describe it.

*Moist: It's the worst.