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.

Saturday, January 10, 2015

Winter break

Sorry for the lack of posts, y'all. I've had three weeks off between contracts and have spent it stuffing my face with delicious food, visiting friends and family at home, not putting real pants on 75% of the time, meeting my best friends' two hour old newborn, eating more delicious food, and generally having a relaxed great time.

Posting to resume when I'm back to work on Wednesday.

Monday, December 29, 2014

Supplies

One of the residents came up to the desk where I was sitting the other night, and said hello, introduced himself, and then brightly asked if we had any reflex hammers in the ER he could borrow for his exam. The conversation went kind of like this:

First-year Resident: Hey there, bummer of a busy night eh? By the way, is there a reflex hammer down here that I can borrow real quick?

Me:


Resident: Uhhh...no seriously...

Me:

Resident: Yeah, I guess I should have brought mine in tonight. I was running late and forgot to grab it.

I felt kind bad for just laughing at him, but when I explained that not only do we not have reflex hammers but are also lacking PowerLoc needles, foley kits, a working tube system, enough staff to work any given day, and cardiac monitor lead stickers, he realized that a hammer was just not on the priority list at all. Plus I gave him my stethoscope to use instead and also foisted a plate of cookies on him to take back upstairs, so I think I smoothed things over well enough.

But lesson learned: the ER won't ever have anything you need or the right sort of thing you want, so bring it yourself to save you the grief. 

Friday, November 28, 2014

Star Wars!

I am cautiously hopeful that the new Star Wars doesn't suck. The first trailer is out today which you should go immediately watch and tell me what you think about it.  But really, I'm just so pulling for this to not be terrible. I'm almost afraid to get excited about it, because I don't want to be let down.

That said...

Yeah, that's me.

And here's the trailer!


Sunday, November 23, 2014

Walter would be proud.

Dude I hate to break it to you, but...declining an ibuprofen for your bum ankle because you "don't like to put pills from big pharma" in your system then almost immediately admitting that you do meth quite frequently just doesn't make sense.

I really don't understand people.

Saturday, November 22, 2014

Oh no...

I've done something terrible at work. Something awful. Right now no one knows about it, but it's a pretty small ER and rumors can travel fast. I'm not even there at the moment but it only takes one person to suspect something and start talking. What do I do if I'm found out? Do I come clean and apologize? Or do I dig in, pretend it never happened and hope it blows over?

I just don't know. It's bad though. Real bad.

I...

This is hard. I don't even want to tell you, anonymous interwebz.

I...

Okay. Deep breath. I've gotta come clean.

I...pooped in the break room bathroom.

I KNOW I KNOW, IT'S TERRIBLE. I just went in to pee, and all of a sudden my butt was like HAHAHAHA NOPE and I had to poo. It's one of the ago old rules to the ER - don't poop where you work. And there were people in the break room! I was mortified. No one had to use the bathroom right after me but I can't hold out hope that I left it unscathed. There had to be some olfactory evidence, because errrrrr-ones shit stanky. I'm not special!

Gah. I think I'd almost rather forget to chart an assessment or have a patient get mad and write me up for something stupid. At least then I'd have the sympathy of my coworkers. Bathroom poobomb? There won't be any kind words for me, that's for sure.

Tuesday, November 18, 2014

Caring.

A few days ago I sat and held the hand of a soon-to-die man who was anxiously looking forward to it. He didn't want to be in the hospital but didn't want to go home. When the young resident finally got frustrated with the old mans' repeated answer of "just let me die, dammit" to all the interventions suggested, I finally stepped in and suggested that we admit the gentleman overnight until his primary doctor could come in since they had an established history and knew exactly what the patients' wishes were for end of life care. The resident agreed although I think it was partly out of relief that the decision was taken out of his hands and partly because he didn't know how to deal with someone who didn't want to get better. Either way, he wrote the admission orders for comfort care and left.

Since I was floating that night and it was a ridiculously slow shift, I pulled up a chair and sat with the man. He told me stories of when he was in the military and met his beautiful wife, how she had a sailor mouth worse than his, and how she was "such a classy broad" who was a down home country girl who took none of his shit yet could doll up with the best of them. He told me of their adventures around the world. He cried when he told me of their struggle with cancer years ago. She beat it once, but eventually it came back. When he was quiet for few minutes, I said nothing. "I'm not looking forward to dying," he said, "but I just can't wait to see her again and give her hell for leaving me so soon."

Together we went through a box of shitty hospital tissues - mostly by him, but I used my fair share too.

Before he went upstairs to his bed he asked me to put the rail down for a minute. I helped him stand up, thinking he needed assistance to the bathroom or maybe to straighten out his sheets. Instead he gave me a great big bear hug and hung on for a few minutes. He thanked me from the bottom of his heart. I told him I'd come see him in a few days when I was back, and he replied that he hoped I was too late.

The next time I worked I called the floor to find out if he was still in that same room. They told me he died a few hours after I sent him up there.

I've become a cynical, jaded person over the past few years. The daily grind of the ER sometimes beats me down and makes me question why I choose to work in a field where I'm verbally abused, often in danger of physical violence, surrounded by people who try to manipulate me into dilaudid or bus tickets or free meals, see ungrateful and entitled people who take advantage of the system, and deal with generally horrible people who have no concept of what it means to be decent. But this man makes me remember why I chose to work in this field. Because every now and then, I get to meet someone like him and truly make a difference.

Wednesday, November 5, 2014

Germs

I understand the Ebola fears circulating. I really do. It's a scary, horrifying disease and just because it isn't ravaging the US yet doesn't mean it can't. People need to take precautions, educate themselves, and not be dumbasses. An incredibly tall and impossible request, it would seem.

I'm continually amazed at how derp people are. I mean, marching into the ER with the N-100 mask ordered from the interwebz to "help me breathe good," demanding a pair of gloves from the triage nurse and then proceeding to keep the same pair of gloves on for the entire visit -EVEN IN THE BATHROOM - is not how any sort of infection is avoided. Loftily telling me that you don't want to sit on the stretcher because "that where a-bola people might sit" is not how to avoid getting sick. Come on, people. Whether it's Ebola or the regular flu or any other communicable disease, not acting like an idiot is the single best thing people can do to not catch something.

I suggested proper handwashing instead of gross glove wearing, and sneezing techniques that don't involve the spraying of snot all over everyone, gave education on the reality of Ebola, recommended a flu vaccine, and - and this is where I got cut off, because she goes "whatever, I know what I doin."

I can't win.



But here's a word of wisdom from me. You don't want Ebola? STAY THE FUCK OUT OF THE ER FULL OF SICK PEOPLE. Don't come in for your made-up complaint, angling for norco, and then bitch to me about how gross the ER is. Guh.

Friday, October 10, 2014

A Dialogue in the ER

"Alrighty, you've been discharged and we can't let you sleep here all night long. Sorry, but you've got to go," I say.

She responds, "where is the nearest bus stop?" I answer that it's about a quarter mile away, north up the street, and kindly hold the door open for her. "Can you push me there in a wheelchair so I don't have to walk?" she asks.

"Um, no."

"Fine bitch," she responds, "then I need a coffee with cream and sugar, and a sandwich bag."

***

Security is next to enter the scene.

***
"Imma mess you up, I know where you live! I'm gonna give you Ebola!" she shouts as security escorts her out on foot. The sound of her screeching fades as the doors slide shut, and I wearily sign up my name to the next patient coming into my group. Abdominal pain, the chief complaint says. And in the triage note I see their first request is for some juice.

***
End scene.




Thursday, October 2, 2014

I'm back, with even more rage!

So, sorry about that time I stopped blogging for forever. I'm back and have stories saved up and shall bring all the hilarity. But before hilarity comes rage.

I'm pretty full of that rage right now, both from stupid stuff and from a confrontation with a nurse yesterday that reduced me to tears and made me feel like I was a new grad with no confidence all over again. But more on that later. First, the stupid stuff rage.

I had to buy new scrubs for this job, and whilst scrub shopping I was slowly building my rage level because of how ridiculous scrub attire is now. You never see scrubs for men with fancy little decorations on them or brightly colored trim or attractive flared darts to make the boobs look nice. And when men wear scrubs, they are viewed as a professional wearing a uniform to get a job done. Women, on the other hand, are bombarded with scrubs with sexy cat logos or boob darts or ruching and slim cut lines to enhance the body and appearance of scrubs. So when a woman wears a pair of scrubs, they aren't wearing a standard uniform anymore but instead are wearing a stylish outfit which just happens to be workwear.

And this this pisses me off. I searched for hours for a plain pair of scrubs. No frills, just a soft-wash pair of pants with simple pockets and a top with two reasonably sized front pockets and without a bunch of decorative stuff. I'm not even joking when I say I was in the dressing room for hours. The sign on the door said 7 items only, but I just looked at the lady with a side eye and defiantly carried in my 25 items.

I finally find a pair to my liking, with all the requirements and in a nice boxy shape so I don't look inappropriate. Imagine the rage I felt when I look at the tag to check the price and saw this:


THE ACTUAL FUCK?! This is a catalog model trying to be a lingerie model. I AM A NURSE. I AM A PROFESSIONAL. Not this shit. I try my hardest to be a good nurse and a professional worker in a well respected career. And this is the type of company I have to buy from. Even when I find a pair of scrubs that fit and don't make me look like I'm trying to slut it up at work, I end up supporting a company who perpetuates the stereotype that nurses are just there to look good and bring water and fawn over the real professionals who are doing the actual work. It's a bunch of bullshit, and I'm sick of it.