Wednesday, September 23, 2015

Hospital manners

I find one of the most amusing things about my decidedly non-amusing recent hospital stay was the speed with which I slipped into the role of shameless patient.

I was an inpatient for exactly 24 hours. In those 24 hours, I did the following:

1. Left the bathroom door open to pee because the IV pole wouldn't fit with me, not even caring that the room door was also open (no direct line of sight - I'm not THAT shameless).

2. I excitedly hit the callbell so I could inform my nurse that I farted! I usually enjoy farting, but the level of glee in my voice was something typically only reserved for the insincere apologies I offer after dutch-ovening my fiance.

3. Ordered a balanced meal from the cafeteria, consisting of two orders of tomato soup, one chicken broth, one cup of hot tea, one cup of iced tea, a smoothie, and an order of chocolate pudding. I sure did house the entire tray without a second thought. Or first chewing.

4. Walked a lot. On one of my multiple pre-fart laps around the nursing station, I had to sneeze but hurt too bad to not splint, so the arm not holding onto the IV pole went to my abdomen. The back of my gown? Left to its own devices. I think I had it tied shut enough, but I can't be sure and I didn't care enough to check.

5. Took full advantage of the fashionable attire available to me. I was admitted after working a 12 hour shift and didn't get to go home prior to checking in, so I was faced with either wearing dirty underwear all weekend or getting new ones. Since the gift shop doesn't include an aerie store, I got to wear the mesh briefs that are so prevalent in the mother/baby unit. They're super comfortable, for the record.

So, yeah. I guess I can laugh all I want about the ridiculous things that patients do, but give me three minutes in the hospital and I'll damn sure check each one off my own list.

Sunday, September 20, 2015

Weekend Plans

Let me set the scene - it's such a beautiful weekend here in Oregon. I had plans with friends to go on a wonderful hike today and then go to a new brewery for some delicious beer. I worked Wednesday-Friday night, and planned on having a great couple of days in the sun.

But then, an unexpected adventure began.

I woke up Friday in the middle of the day with some vague belly pain. It almost felt like hunger pains, which since I didn't have breakfast after work didn't really sound that weird. I got up and had a banana, and it didn't help at all. I went back to sleep, not restfully, but figured I had one day left of work so I'd just stick it out and go.

Halfway through my shift, I felt terrible. I had this awful periumbilical pain which was just constant, I didn't feel hungry at all, and then the occasional wave of nausea would hit. Pepcid and tylenol didn't help, and I continued to feel worse. Towards the end of the shift, it hurt to get up or sit down in my chair to chart. I couldn't stand up straight and constantly hunched towards the right. I went and talked to the overnight doc because I knew deep down what it was but didn't want to believe it. After hearing all my symptoms he just gave me a look and told me to go check in as a patient.

Side note, I bet most ER nurses can back me up on this - we rarely check in as patients in our own hospitals, and must essentially be on death's door step to do so. It's the whole "no foleys between friends" rule, I guess. But I digress.

I continued to stick it out the rest of the shift, miserably. When the day shift came on, I handed off my patients to my replacement but before I could do anything else the charge nurse and night doc corralled me to ask what I was going to do. Then they pulled the day shift doc over, and told him my story. "Oh yeah," he said, "you've definitely got appendicitis. I walked around like you are right now for a whole shift and then mine ruptured."

Long story short, he did a quick exam and I had all the classic textbook signs for an appy. I agreed to check in, my WBCs were 14K, and he didn't even bother with a CT before calling the surgeon. I ended up in the OR by 10:00, and this is what they found:

So yeah. I totally had appendicits. And it sucked. You know what else sucked? Being a patient. This was my first time ever going to the ER, first time getting surgery, and first hospital admission. All while being across the country from my family and my fiance. There will be another post about how strange it was to be on the other side of the bed rails, but in the meantime I will say that my coworkers were absolutely fabulous. From offering me places to stay, to visiting me in the hospital room, to bringing me pajamas so I wasn't bareassed in a thin gown all night, they were fantastic.

To end this story, I just want to say how awesome norco is. I hurt right now, but nowhere near my pain from yesterday. Thanks, narcotics! I won't be thanking you when I'm constipated for the next three days, but we'll cross that bridge when we come to it. Also, I'm totally blaming any grammatical or flow errors in this post on the fact that I'm taking pain meds.

TL;DR - I went to work Friday and didn't go home after my shift. Instead I worked 12 hours feeling like shit because I had appendicits, then I went to the OR and said good riddance to my useless vestigal organ. Then I spent the night in the hospital feeling super dopey in my stupid socks and wheelie IV pole, and now I'm back home with awesome pain meds writing terribly edited blog posts. Huzzah!

Tuesday, September 15, 2015


Le sigh. I try and write something to express the rage inside me, and yet again GomerBlog has done it way better. Satire always wins.

Littman to Produce Separate Doctor and Nurse Stethoscopes.

"We always thought nurses actually used [them] to assess their patients so we just sold the same stethoscopes to all providers. Now that we recognize that most nurses just use a stethoscope for 'the look...' game changer!"

The View and why the phrase "doctor stethoscope" is so very wrong.

Making the rounds on the internet this week is a clip from The View regarding Miss Colorado and her monologue from the talent portion of the Miss America pageant.

Here's the video in case you haven't seen it:

(youtube credit to Kathryn West)

If you don't watch it, here's the gist: The View hosts are discussing the various talents demonstrated, and focus on Miss Colorado who talks about her work with Alzheimer's patients in relation to her job as a nurse. Miss Colorado is then mocked for "reading her emails" instead of performing a real talent, and there is an offhanded comment by Joy Behar about her attire - namely, her "doctor stethoscope."

I want to let that sink in for a moment.

Her "doctor stethoscope."

In two words, the women on The View manage to completely dismiss an entire profession. According to the AACN, there are around 3.1 million RNs nationwide. Three point one million. That's a lot of nurses. They work in Emergency Departments, hospice groups, nursing homes, Operating Rooms, administration, and a multitude of other departments. I myself work in the ER. And I've never once, in almost seven years of work, had my stethoscope referred to as a "doctor stethoscope."

I've never had my stethoscope referred to that way because there is no such thing. It is a stethoscope. Utilized by both doctors and nurses. And while our job functions in healthcare are different, they are both valid. To illustrate this, think back on the last time you went to the ER. After checking in with a triage nurse, you come back to a room if one is available. If not, the triage nurse makes the determination that you're safe sitting in the waiting room a bit longer while other, more critical patients are brought back first. When you do come back, the primary nurse is the first one to assess you. Why? There are more nurses than there are providers. Unless you're critically ill and the whole team is waiting for your arrival, generally the nurses assess you before the doctor ever comes into the room. The nurse listens with a stethoscope, to your lungs, your heart, or your abdomen to get an idea of what is going on. Do we hear abnormal breath sounds? No breath sounds at all on one side? What about a heart murmur? Are those bowel sounds hypoactive? Do your physical complaints match up with your story? What other symptoms are you having, and for how long?

All of these questions are part of our assessment. An assessment that is done entirely independently of a doctor. An assessment that may determine if the doctor gets pulled in to see you immediately or if you can wait until your turn. An assessment that goes into our documentation and into the medical record. An assessment that can be questioned in court if needed. An assessment that is taught in nursing school to be thorough and correct.

We don't learn all of this just so we can use a "doctor stethoscope" and pretend to know what we're doing. We aren't an accessory to physicians and only exist in the hospital to be eye candy, find bedpans, or make coffee. We've never bought "doctor scrubs" or "doctor shoes" or "doctor clicky pens" to wear during our grueling 12 hour shifts without lunch or a bathroom break.

We are the ones that you see first. We will be the professional with you the vast majority of the time. We're the ones who will start your IV, hang the medication and titrate it to a desired response, stand in the room with your family after time of death is called on your loved one, monitor you for improvement after you've received treatments, and hit the code blue button if you try to stop being alive. We get you up to the bathroom and wrangle the oxygen tubing as well so you don't desaturate. We work the highly specialized equipment you may require, like ECMO. We're the ones who constantly monitor your vital signs and notify the physician when they start to tank. We are the ones who are with you enough to notice when something doesn't seem right.

When the phrase "doctor stethoscope" is blithely uttered by someone who has no concept of how nurses actually function, it denigrates our entire profession. It shortchanges over three million healthcare workers in this country and makes the statement that the only people who matter are doctors. This infuriates me.

We matter. We are educated professionals, and we are not to be dismissed by someone so ill-informed as to carelessly assume we're just accessories. The fact that the women on The View even feel this way is the most upsetting part - if they view nursing so poorly as to offhandedly state this in the first place, how can we ever expect the general public to understand that what we do is mentally, physically, and emotionally difficult?

I don't know the answer to these questions. I wish I could more eloquently express the amount of rage, shame, and disappointment I feel over this video and the deeper opinion held of nurses. I wish I had a better outlet to educate those who agree with the women on The View. I wish I could change the perception of nurses to be as respected as physicians. I wish a lot of things, but mostly I wish I didn't have to fight this fight.


YOU GUYS. I'm super excited! I've been wanting to learn photography for a long time, and finally took the jump and bought a nice camera. I don't ever plan on becoming any sort of professional - I just want to learn how to take great pictures and have some control over the kind of shots I get.

So with that said, I treated myself to a Nikon D3300 as my first step into DSLR. It's quite the upgrade from my current iPhone and old coolpix point-and-shoot. With that said, oh my good lord photography is overwhelming. Seriously. So much information.

I'm super excited to start learning this art though, and I'll keep you all updated on my progress. Feel free to send some tips my way, especially ones that helped you not feel totally in over your head in the beginning.

Saturday, September 12, 2015

Hug it out

If I've done it before, I can't remember - I asked to hug a patient last night, because she was the absolute nicest, sweetest, hilarious lady who got dealt an awful hand. I've said it so many times before, but cancer is the worst. I am in complete awe of this lady, who took bad news so well and it just breaks my heart when people who are so clearly just good are faced with this fight.

I hope if I am ever at this same junction, I can act as classy as that lady.

Thursday, September 10, 2015

The Batmans


In honor of the end of the Key & Peele, I present to you my most favorite sketch. Besides the eternally hilarious Substitute Teacher, that is.

Tuesday, September 1, 2015

Son of a...

Sometimes we get a psych patient with real medical issues, and sometimes we get a medical patient with background psych issues. Either way, they're a challenge to take care of. The psych aspect to the care means that the medical stuff is harder to do - the patient is often either unable or unwilling to comprehend why certain care is being given, and it can make for a very difficult time. Mostly it's just a sad feeling to be taking care of someone who got dealt such a shitty hand in life.

Sometimes though, the psych issues and the medical issues join forces in a glorious display of hilarity. Like, for example, the sweet guy I took care of the other day. He was withdrawing from alcohol, which is awful, and also had a myriad of mental health problems. One result of his psych background was a deep abiding love for Jimmy Buffett. It was such a deep love that he was convinced he was actually Jimmy himself...and sang, at the top of his lungs, Son of a son of a Sailor. For a good twenty minutes. Remarkably in key, too.

That song happens to be one of my favorites which meant I essentially had a personal mini concert from JB. His singing was enough to draw a crowd of security guards, other nurses, and the doctor. By the end of the extended song, he got a round of applause from the crowd and serious props from me. I guess the joy from singing worked wonders, because after the concert he was the best patient ever.

He even said thank you for making the tremors stop, and was generally the most cooperative hallucinating withdrawal patient I've ever had. And the best part? He proclaimed that my reward is lifetime tickets to every one of his concerts and a free meal at Margaritaville.

Mental illness is hard. But sometimes, just sometimes, there's a bit of joy to be found in it.

Monday, August 17, 2015

I'm back!

I'm back!

So sorry for the extended hiatus - it's been a busy couple of months. I visited Oregon with my boyfriend and his family, jumped off a cliff into Crater Lake (see previous post!), went on a ridiculously fun friend trip to Vegas, won money at blackjack, drank for free while playing blackjack like a boss, visited the East Coast for my usual summer trip home, went to the lake with family, saw friends and old coworkers, ate the most delicious of food, moved out of my wonderful Texas apartment, started my assignment in Oregon, and oh yeah - got engaged!

I was proposed to in beautiful Shenandoah National Park in Virginia, which happens to be one of my favorite places on earth. I got a beautiful ring from a wonderfully excellent dude and I'm super excited to be with him until we're old and crotchety on the front porch together. Related to all this, I feel I am a fairly laid back person. I try not to give too many fucks about things that don't matter, and I think I'm mostly successful at this. That being said...I could feel myself turning into a crazy person when it comes to planning and money and all the things. Hence the hiatus from blogging.

But now I've got most of the major details knocked out, a budget, friends to make me not crazy, and I'm halfway across the country in beautiful Oregon. Blogging shall resume as I've already got plenty of interesting stories from this new assignment and a ton of gorgeous nature pictures to make you all jealous over. Thanks for sticking with me over this break in writing!

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


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


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


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.