This Christmas...

Five days, kidney stone, septic shock, levophed and vasopressin, cipro and vancomycin and meropenem, failed vent weaning trials, new onset afib with RVR, unsuccessful cardioversion x2, amiodarone, and my grandmother has spent Christmas in the ICU.

Well, shit.

Hospitals are so much easier when you have no attachment to the patient.

Blogging will be sparse until things improve.

Upgrade trauma code

We recently had an patient who came in after an MVC. She was hurt pretty bad, but nothing that was life threatening. We were holding her in the ER while waiting for an inpatient bed, and everyone kept walking by the room and giggling.

Why giggling?

Because in the persons car, safely placed in a carrier, was her very vocal kitty.

A very vocal kitty who, because it was cold outside and because family was still hours away, was now the proud occupant of a kitty carrier in the corner of the trauma room. Just picture the scene: grumpy trauma surgeon called into work in the wee hours of the morning, bleary eyed and annoyed at being dragged out of bed on a sub-zero night. ER staff, bright and perky and giggling hysterically every seven seconds. Trauma surgeon, placing a traction pin while the cat is yowling in the corner...non-stop...for a solid half hour.

It was beyond fantastic.

The owner ended up being okay, and was transferred upstairs. Family came to visit, and we promptly discharged the cat back to its family.

The best part, however, is that because the carrier was restrained, the kitty met the qualifications to not be trauma coded...

Proof that seatbelts do work!

The five stages of grief

In nursing school, we spend like four days on learning the stages of grief. I think we should have just watched this instead:



It certainly would have allowed for many more important things...like cultural issues! Wait, no, we spent two weeks on that one too...

Patient vocab

Me: Is this just a pacemaker, or is it a defibrillator as well?
Patient: Wait, what?
Me: Does this thing make sure your heart beats every time, or does it shock you too if needed?
Patient: Oh, yeah, it's defibulated me a couple of times just this month!

Defibulator: That little device which shocks you at a later time if you lie about its purpose...

Full moon

Good grief. Tonight was the night from hell. For reals.

I only discharged like three patients the whole night because everyone was either 1) really sick, or 2) high drama and sobbing in their rooms until they got admitted for "acute pain."

I have never wanted to slam my head onto the desk so many times in one night.

I have never wanted to strangle so many patients with their call bells and IV tubing before.

I have never understood better how accurate the full moon superstition is.

I am most definitely going to sleep well tonight...and go nowhere near the ER.

Real life

I am 24 years old. I have gone through grades K-12, gotten my BA in 4 years and BSN in 18 months. I have been out of college for exactly one year now. I have been working as an RN in the local ER for slightly less than one year. And I am just now discovering how different the real world is from school.

For all of my previous years in school, when the holiday season rolls around the universities shut down and you get to spend that time with your families. Even working part time jobs during those breaks still allows for sufficient quality family time. I have now discovered that the real world is slightly different.

I work this Christmas. When many others are rushing downstairs to open presents, I'll be finishing a graveyard shift. When families are heading off to the candlelight church services, I'll be arriving at the ER with a giant cup of coffee. When my friends hang out around their trees with a cup of hot chocolate, I'll hang out around the accudose with my now half-empty giant cup of coffee.

So what will this workday end up like? Will it reflect the wishful Christmas spirit, where good things happen and miracles occur and people pull through and everyone is happy? Or will it be like any other day in the ER, where people cry and lives are disrupted and I have to hide tears while being strong for others? Or will it be a combination of both, where people hear the worst news of their lives but somehow find that extra strength to get through it?

I'm really not sure what to expect, but I hope it isn't too bad. I want to be optimistic but as I've already learned, real life isn't always generous. At any rate, I'll find out next week. And as this is only my first of many working holidays, I'm sure I'll find out again and again and again over the years.

Aunt Clara had for years labored under the delusion that I was not only perpetually 4 years old, but also a girl

Listen, I'm sort of a Grinch when it comes to Christmas. I love love love the fact that we are celebrating the birth of Christ and get to give because we love to, but I'm not a big fan of celebrating Christmas for like three straight months. I strongly dislike Christmas songs except for the occasional carol. I get sick of red white and green by about December 3rd. I think that Verizon Santa and reindeer commercial is silly. I suck at writing cards and I never seem to work up the energy to buy gifts.

Basically my heart is two sizes too small.

But you know what? I love A Christmas Story with all my heart. Sweet mother that movie is amazing, and redeems the entire overblown debacle of "the holiday season."

I might even sing a little Christmas carol to go along with this...

Tiger's Christmas card photo

My Dad is great for many reasons, one being that he sends me emails like this:



All I'm sayin is...had Tiger cheated on me, I wouldn't be holding that club anymore because it would be embedded so far in his nether regions it would be invisible.

Enabling

"I have cramps and I have endometriosis really bad. I get percocets for the pain. My pain is a 10/10 right now."

I see. So what did you take for your pain today?

"I took a tylenol yesterday, but they don't never work."

Apparently that bag of cheez-its you're plowing through at 0300 isn't helping either. Face, meet palm. I should also mention that she was wearing skinny jeans and 5 inch heels, texting the entire time, and sucking down a pepsi like it was the last one on Earth. Oh, and had visited the ER six times in three months for cramps...that math just doesn't add up.

Without hesitation, the PA wrote her a prescription for to-go 5 percocet, plus a script for 14 more. For. Cramping. I called the PA up and told him I wasn't giving it. He could if he wanted, but I wasn't doing it. After soundly berating my decision, he ended up giving her the discharge stuff and doing the teaching himself.

Whatever. At least when she comes in at the age of 35, cracked out and addicted to all sorts of painkillers and whatnot, my conscience will be clear.

Blogging is a lifesaver.

So I'm a new nurse. I often feel overwhelmed, wonder what the heck I'm doing here, and wonder if I'll ever be smart enough to be a good nurse. I get sick of the stupid people, and often want to tell people it's their own stupidity that has made them sick. I want to really tell it to the drug seekers. I want to stay home some days. I want to go home some days in the middle of the shift. Some days I think to myself, "I'm never coming back."

But then I go home and blog about it, and it's all better. And I owe it to Nurse K!

I started reading her blog way back in the dregs of nursing school, got inspired to start my own blog, and when I read this post I thought, "well played, shrtstormtrooper. Well played."

Experienced nurse to new trainee: "Just to warn you, this job will beat you down. You'll be tired, you'll not want to come some days, you'll question if you're really cut out for this, SOBs and drug seekers may even make you spiral into a depression that you can't explain. It's okay, I'm your preceptor, I'll help you through it."

I just wanted to say 'if the shit is getting you down, start a blog and never, ever tell anyone about it ever even if you're the 3rd most popular nursing blogger in the country.' ;-)

Maybe one day my blog will be just as popular. And no one at my job will ever ever know about it!

******
Is it too soon to joke that GM is on the fritz?

CNBC: General Motors CEO Fredereick "Fritz" Henderson to resign

Say Eight!

Brian Regan. Funny. Watch it.



Go ahead, merge.

Hearts

A patient I was taking care of recently asked me how long I had been a nurse. I most always try to downplay the question because sometimes people get uneasy with an unexperienced nurse - and sometimes rightfully so. Usually I'll tell people, "I've been here almost a year," which while is completely true, sort of sounds like I've worked somewhere else, too. Most people are satisfied with that answer; some are not. This patient was of the latter group, and asked me when I graduated school. I told her and then waited for the inevitable comment about the obvious new nurse-ness, something glaringly obvious that I missed which pegged me as inexperienced, or even something negative.

Instead of something negative, she mentioned that I had been very sweet to her, and remarked that even with my new nurse-ness, she appreciated the care I had given. She mentioned how a lot of her nurses had been crusty and mean and impatient, but that I had been very pleasant and willing to listen to her complaints. I thanked her, then jokingly replied that I haven't been a nurse long enough to be heartless yet.

She says, "you nurses never lose your hearts, you just learn to protect them better."

A very interesting perspective, I must say.

Physics is fun!

The LHC is back up and running! I was excited about this a year ago when I blogged about it, and I'm still excited. Mainly because I'm a giant nerd, but also because it's really cool.


Beams of protons circulating at nearly the speed of light and then smashing into each other? Awesome. Learning more about the Big Bang (or Horrendous Space Kablooie, if you will)? Awesome! Giant superconducting magnets operating at almost absolute zero? 0°Kelvin? -459°F? Um, awesome!

But I digress. And even if you're not interested in any of this, I'm sure you'll be interested to know that even with the powering up of the LHC and the potential black holes created and subsequent end of the world, we can check to make sure we're okay with just one little clicky.

Go ahead. Clicky Linky.

I can die happy

I saw Star Wars in Concert tonight.

Star Wars. Big Screen. Lasers. Full Orchestra. Anthony Daniels in person!

Sweet mother it was awesome. It was 24 years of Nerd-dom finally come to fruition. It was glorious!



You're jealous, I know. Or maybe not. I don't care either way, because I saw it and it was awesome and if I kick the bucket tonight, I'll die happy!

You want some more? Okay. I can't resist anyway...

Somebody get this girl her kidneys!

I am shamelessly reposting this from Movin' Meat because It. Is. EPIC!

-The boy in bed twelve ate pop rocks and coke.
-F**K! We don't have much time!

See more funny videos and funny pictures at CollegeHumor.

We've lost them. All of them.

This is so glorious I watched it multiple times. And then a few more. Thanks, Shadowfax.

Cause?

New(er than me) Nurse: Her sats were 95% room air earlier in the day, and then just a few hours later they were 60% on a mask and she had to come here. Her lungs were clear on the first check, can sats really drop that fast?

Old Grizzled Nurse: Depends on how heavy the pillow is.


I almost choked on my chicken noodle soup. I love night shift.

Shrtstormtrooper, the Barbarian

Sometimes it's hard to watch tv marathons throughout the night without getting crazy ideas. It's even harder when the marathon show in question is Mythbusters.

I stayed up late tonight so I could sleep most of the day today, and of course I ended up staying up all night. Fortunately Discovery Channel had a Mythbusters marathon on. Usually Adam and Jamie admonish us with the warning of "don't try this at home!" but today they encouraged me to go ahead and try. And who am I to argue such scientific reasoning?

The myth in question was whether or not two intertwined phone books (no glue, no rope, no brace of any sort) with actually hold themselves together against a lot of force. For the record, they can withstand 8000 lbs of pressure. In case you wanted to know.

A little side challenge is what piqued my interest, though. Can you rip a phone book in half? Surely not! Ah, but wait, says Adam. I followed his directions. I found a phone book in my drawer. And BOOM. Look what I can do!


I feel like the Hulk!

Excuse me while I whip this out

While sitting through a staff meeting today and listening to the management discuss the changes to come, this is all I could think of:



Methinks it's pretty close to the truth...

Deep rooted issues?

I had wickedly crooked teeth as a kid, and my parents forked out the money to get me braces. Which is something I'll be eternally grateful for, without a doubt. Unfortunately, visiting the dentist once a month for two years has left me with an ever growing fear of that metal instrument-welding spawn of Satan.

Well, maybe "Spawn of Satan" is too harsh. My dentist was actually a super nice guy, and I went to him (very sporadically) even after I turned 18 and was too old to go there because he still gave me stickers and a new packet of floss each time. I even went back to his office to get XRays for both of my wisdom teeth removal adventures.

Somehow though, through the years of endless fittings and metal mouth and snapped wires and bleeding gums and wisdom teeth removals, I've slowly become terrified of going to the dentist. I'm not really sure why; I think it might be the sounds and the smells and the tastes and the dislike of having someones fingers in your maw and then they ask you a question and chuckle when you "aaahh mmmnnnii eehh" your Baleen whale response. So really, it's everything.

Thus, I haven't been to the dentist in years. I've lost track, but I think it's probably 4 or 5 years since I've gotten a flouride treatment, good cleaning, or filling. Even the thought of sitting in that chair gives me chills now. I am seriously scared to go see one. Like, numbing, paralyzing fear. I can't even watch oral surgery on tv, and I normally love blood and guts and gore and watching those televised OR cases.

Today, while brushing (and flossing, thank you very much) I was pondering the state of my teeth and decided that I really do need to see a dentist. I'm 24 years old, own a new car, rent my own apartment, have a career-type job, and pay for my own health insurance. I should be old enough to make my own dental appointment, one would think. So I gave myself a long pep talk about the benefits and necessity of regular exams. I thought of my friend AB from nursing school who is also a dental hygienist, who reminds me often that I need to get my butt in gear. I thought of the likely cavities lurking in my mouth, and how I don't want my teeth to fall out and I should take care of myself better. Man up, I told myself.

Seriously, my pep talk lasted a good 20 minutes. I finally Googled some dentists around here, picked a decent looking one, and held my cell phone with the number dialed in for a solid five minutes before I pressed send.

It rang, and rang. And rang.

And then it dawned on me.

Today is Sunday.

Sunday.

Frick.

It might take me another year or two to work up the courage to try again...

"Lando gave some tips while we were talking..."

OH SWEET MOTHER THIS IS GLORIOUS!



So glorious it deserves an all-caps introduction!

Halloween

Halloween night in the ER is always an interesting time, I've heard.

And they were right!

I ate my weight in candy, was busier than I had any right to be, and was thoroughly entertained by the antics of everyone involved.

But perhaps the most amusing part of the night was the high school student who discovered that even if you manage to get out of your parents house to a Halloween party, when you get so drunk you crap yourself your friends will dump you at a gas station so someone else will call the cops.

His neon-colored tights and high socks went well with the green and brown vomit and poo, and I was impressed by his ability to become coherent enough to warn us, "I'm going to crap myself!"

I learned that when betting on the BAL of a hammered teenager, don't bet high. One of the doctors took one look at our guesses, and goes, "oh, you youngsters. You'll learn that they can't hold their liquor." And then promptly bet the eventual winning number.

I also learned that even more fun than the candy, jokes, and costumes was the knowledge that we get to call the drunk kids parents...and then all giggle as the parents unleash high hell on said drunk kid as he is wheeled out the door, head in hands.

Yes, Halloween night is interesting in the ER.

Insomnia

So it's currently 05:22, and I can't sleep. I've been laying wide awake in bed since 02:00. I do love night shift, but I do not love the havoc it wreaks on my off-time snooze schedule.

Probably another reason why I can't sleep is that I had another one of those bad nights at work this week. Not where I did anything grossly wrong, but I just felt stupid all night. I even said something really, really stupid, which I will not share with you because I'm still mortified by it. I knew what I was thinking in my head and it was a coherent and correct thought; It just came out wrong and made me sound like someone who has never ever been through a single nursing class before. Ugh, just embarrassing.

But besides that, I spent the whole night feeling dumb. Bladder irrigation? Sure, I know the process in theory. Setting it up in the middle of a critical situation, however, is a different story when you've never done it before. Also worked with some critical med drips that I haven't handled before. Not so scary, except that when you have to print off the infusion chart from the computer and then track down a more experienced nurse to make sure you've mixed it right and then hang it and wait for a central line access and then try not to get in the way of the doc, trauma surgeon, six RTs, eight RNs, and three techs rotating CPR can be a little overwhelming.

Running a heart attack protocol? Easy in theory. Not easy when this is the first one I've ever run and the cardiologist is not sympathetic to my new nurse-ness. And especially not easy when there is a whole other set of symptoms not related to an MI that we're trying to figure out. I sort of wished for one of those cases where you think the guy looks funny, hook him to an EKG, and watch the machine print out the "ohh...uh oh...oh shit! those are tombstones" paper, and BOOM it's a STEMI, jam some aspirin and nitro down his maw and zoom off to the cath lab. No, I couldn't get a straightforward one like that to start with.

I guess the reason I'm feeling so down on myself is because it's been almost six months since I've been off orientation and I still sometimes wonder what I'm doing here. While I've become competent in the small things, the big things still make me think, "there's no way I'm allowed to do this!"

There is something called the Impostor Phenomenon, which is when students and newly graduated medical field professionals go through a length of time in which they feel as if there is no way they're smart enough to actually be successful; instead, they think the success is due to being in the right place at the right time, a lucky break, or convincing others that they're smarter than they appear.

I most definitely am going through this right now. I sort of feel that whenever I successfully not kill someone, it's due to the help of the charge nurse, or more experienced nurse looking out for me, or just the fact that no one realizes yet how dumb I really am inside. Eh, it's just sort of depressing to know that you're the least intelligent, least experienced, lowest on the totem pole, most useless person in the room at any given time.

One of these days, I'd like to be the nurse the people can look at and think, "excellent, Shrtstormtrooper is here, so maybe this won't be such a giant cluster."

I definitely do love my job with all my heart...I'm just wondering when I'm going to be a good nurse and not just a dumb new graduate posing as a good one.

***
Well - this turned out to be more of a downer than I planned!

So to end on a light note, I just checked my stat counter and saw that someone reached this blog by Google searching "Idiot reading a book."

Love it!

Ready to go

I recently had a patient come in for belly pain. He was elderly and very sweet. I'm asking him all the routine belly pain assessment questions, asking if he has any sort of medical history that could help me out - do you still have your gallbladder, history of ulcers, GERD, diverticulitis, does your pain radiate to your back? Anything? He thinks for a minute, and then says, "well, I do have an aneurysm." I ask him to show me where, and he points right to his chest. And then to his belly. "I've got two of 'em," he says. In my head I'm thinking that this is it, his aneurysm is seconds from exploding and he'll be dead before the end of my shift. On the bright side, everything is stable. No pulsations, normal BP, good color. Nothing but the persistent pain.

I move him to a room closer to the nursing station, and we quickly order a CT. When it comes back, the doc and I huddle around the monitor to look.

It turns out that his aneurysm had expanded since his last CT, but was stable. His AAA was, I kid you not, more than TEN centimeters in diameter. And the aortic arch wasn't much smaller. The doctor went in to speak with him to explain that the pain he was experiencing was most likely related to his aneurysms, but that due to multiple factors surgery was not an option. He was okayed for discharge with the knowledge that his aorta is a ticking bomb, but that today wasn't his day to die.

He took the information remarkably well, but I couldn't quite figure out why. As I was getting him into his wheelchair to leave the department, he started talking with me about his life.

"You know, I've tried to be a good person both inside and out. I took care of myself, I tried to give back to other people. I tried to be a good person, and my wife was much better than I am. She and I were married for over six decades. My wife died earlier this year. She was the better half of me, and when this artery goes, I hope she is the first one I see."

He knows his aneurysm is going to rupture one day. He knows he will feel fine one moment, then feel ripping pain for a few. He knows that within a minute or two he'll be dead. And he's not only ready to go; he's looking forward to his reunion with open arms and open heart.

No one expects the Spanish Inquisition!

One of the reasons I enjoy night shift so much is because night staff likes Monty Python way more than day shift does. Thus we have many things to endlessly quote. And which I must now share with you, dear reader.

First, you force him to drop the banana. Next, you EAT the banana!


Our chief weapon is surprise, surprise and fear, our two weapons are surprise and fear and ruthless bigotry...



Well sir, I have a silly walk, and I'd like to obtain a government grant to help me develop it.


It never gets old!

The key to understanding sports

My mom always made it to all my high school sports games. She traveled with me for softball in middle school. She tolerates me yelling at the TV for NFL games. We've occasionally gone to NCAA basketball games. She's had a lot of exposure to sports throughout the years. However, she never really got into some sports like I did or grasped the rules as easily as I did, and I didn't know that she thought about this as often as she does.

What I did know is how funny my mom is, especially when ruminating about said lack of sports knowledge:

Now those days a long gone and I'm finding myself trying to watch and learn about sports again. Clearly it's easier these days. The Skins stink, so I'm learning from the comments made by other as to how they should be doing it. This is the missing link in the chain that would have made me knowledgeable. The team has to be a loser! I learned so much from my family and friends this season as we struggle to watch a failing team's efforts. I'm learning what you are supposed to be doing, what they aren't doing correctly, stats from their past and present and stats from other teams too. I even learned when a loyal fan switches teams.

Love you, Mom. And at the rate the Skins are going this season...you'll be an expert on them by the end!

***
I also just saw this trailer on tv: The Men Who Stare at Goats. I was mildly intrigued, and then Ewan McGregor asked Clooney, "so what you're saying is that you were a psychic spy?" Not so interesting. Until Clooney responded "A Jedi Warrior." If that's not using casting to a maximum effect, I don't know what is.

Anyway, I'm hooked. Multiple Star Wars references? Ewan McGregor? A goat? Boston music playing during the trailer? Count me in.



Srsly.

Things I can't handle

I have learned many things since starting my job as a nurse. Most importantly, I've somewhat learned how to be a nurse, although I have a long ways to go.

I've also learned that there are some things that just make me queasy. And they're not the normal quease-inducing things that might normally affect other people. For example, I've had a patient roll over in bed and vomit directly onto my shoes. I've held fingers that are only hanging on to the rest of the hand by a few strings of skin. I've become closely acquainted with the nether regions of patients, whether it's placing a foley or enema or suppository. I've eaten a meal whilst discussing the variations in smells of blood, poo, vomit, and gangrene. I've made (very realistic) fake poo as a prank.

I've put my finger into the depressed skull fracture of a dead person. I've taken the rectal temperature of a dead person. I've taken a dead person to the morgue. I've wiped up pus after the doc lances a butt abscess. I've cleaned up raging diarrhea from a morbidly obese patient while that patient lays in bed - and still continues to spew forth more and more c.diff even while I'm wiping. I've unwrapped "a little cut" and with some quick probing realize it's a 10 inch long scalp laceration so deep I can see the skull. I've unwrapped "a little cut" and had a spurt of arterial blood land six feet away on the floor. I've unwrapped "I think this is a bad cut" and realized parts of flesh are missing completely. I've seen both little and bad cuts get stapled, steri-stripped, and stitched back into place.

I've seen, smelled and touched things that no normal person should ever come in contact with - and yet not only do I not get grossed out by these things, I actually have no negative thoughts towards them whatsoever. Some things, like blood spurting and limbs falling off and cracking a chest are actually really cool.

But lest you think I am impervious to all things gross, I have discovered that there are two things that gross me out, and one thing that threatens to make me pass out.

Two things that gross me out:
1. Anything that deals with eyeballs. Like touching them or having to deal with potential eyeball trauma. I saw a patient recently who had a traumatic eyeball injury, and it was gross. Heebie jeebie.

2. Loogies. There's a reason I'm not a respiratory therapist. Sputum is just, yeegh. I watched a trached patient cough a loogie halfway across the room, and I threw up a little in my mouth.

But for the one thing that threatens me with an ungraceful syncopal episode? Bones. Ortho stuff. Crunchy out of place bones. Dislocated joints thunking back into place. Ugh. The weird thing is that a badly mangled bone just minding it's own business doesn't bother me at all. Only when we start to manipulate it does it bother me. The power drilling, reducing, splinting, traction applying, and crunching really just makes me...whew...

I'm queasy just thinking about all the examples I could write about.

Let's just hope I have already reached my quease-inducing maximum number of things. I don't really want to discover any more.

Whew

Man, it's feast or famine in the ER, seriously. I'll go a month without a super serious trauma, and then get slammed with two back-to-back in a night. It's like the EMS crews just ride around and look for accidents to bring us! I don't know how it happens!

What I do know is that sleep is so much sweeter after an awful night!

Drivel

Sorry it's been so long since I've posted! I had a busy week at work, then went camping all weekend. Good times, especially since no one was eaten by a bear.


And a few random tidbits:

Lucky win for the Skins today...will Zorn and Campbell have a job next week? We shall see...

Whilst browsing the interwebs, I found this wonder. Is it too much to hope for as a Christmas gift?

I burned grilled cheese today. New low for my cooking skills? I think so.


I promise I'll have some actual content this week...I just need to stop being so lazy!

Today

Trying to decide what sort of day today is...

Pros:

• Found my favorite ballpoint clicky pens at the store

Cons:

• Woken at 08:30 to tractors flattening a dirt pile outside my apartment
• Couldn't get back to sleep, get out of bed at 10:00
• Have to work tonight, and couldn't catch a nap all day
  
• Eye exam shows my eyes are worse than before
• After being told my insurance was accepted at Wal-mart, I get the exam and buy two packs of contacts - and then am informed that I'll have to submit my claim since my insurance actually isn't accepted
• Where's my cell phone?
• I have one of those super painful under-the-skin zits on my jawline
  
• Work tonight is night one out of three
  

So what's the verdict?

...

And it's clicky pens for the Win! I choose to have a good night tonight despite the Fail start! Carpe Diem, my friends!

Limits

So many people think that discussing end-of-life care with their doctors is tantamount to those doctors deciding to cut the life support on all the old people just because they're old.

That couldn't be farther from the truth.

I think those of us who work in hospitals understand - being old and being old and sick are two very different beasts. You can be 85 and in very good health with a sound mind. Or you can be 70 and demented, incontinent, bedbound, and doomed to a nursing home.

I can't even count the number of nursing home transfers we get in the ER where the patient is so far gone mentally and physically that I'm not sure how they made it through the night, yet their paperwork clearly states "Full Code." Translation: break Granny's ribs during CPR, put her on a ventilator she'll never come off of, pump her full of drugs her already failing organs won't be able to handle, and send her to the unit where they'll feed turn and water her every day for a month until she dies of sepsis.

So much of the outrageous cost of heath care comes from this futile care. Just because we can keep someone alive, does it mean we should? Where does the line get drawn? When can the doctor step up and tell the family that she'll die either way? When do I get to explain to the family that if Granny had severe dementia before, this little 45 minute CPR battle most certainly isn't going to bring back any mental function?

I think that right now there is no hope of setting limits in health care. Too many people will decry the "death panels," call them doctors who play God and presume to hold the key to life and death. Lawsuits will rain down on those who try to set limits by those who have no understanding of what it is to watch futile care being performed.

Perhaps the only option is to face this head on; to sit down and talk with our doctors over what we want done when we're close to death. Death is never pretty, but it doesn't have to be agonizingly drawn out. I for one will never be a Gomer hooked to a ventilator, drips hanging into IVs, with no hope of recovery. If I've lived a full live, I will make sure everyone around me knows to come say their goodbyes and then let me go peacefully.

I think if we talk about this enough, maybe people will understand.

Here's a start to the talking: a solid Newsweek article titled The Case for Killing Granny. Read it, please. And then go share it.

Shock

I couldn't believe it. This just never happens. I mean seriously, this never happens...

Very elderly man comes in with a legit complaint. When I ask him to describe his problems to me, he concisely and excellently describes his issue, along with how long he's been bothered by it and when exactly he noticed the changes start.

I ask him for his meds, and he gives me a detailed list with every single med, dosage, and frequency.

I ask him for his allergies, and he shows me his allergy bracelet with his true allergies. He then says "there are a few meds I don't like to take because they make me feel like I will get ill, but I'll take them if I have to because that's not really an allergy."

I ask him who his PCP is, and he promptly names his PCP, along with his cardiologist and pulmonologist.

And if all that isn't enough, he then goes, "and I know this isn't a life or death visit, so I'll understand if you have more sick people you need to take care of. I'm in pain, but you take care of the sick people first."

W. T. F.

I had to scrape my jaw off the floor. And then I wanted to give him a hug.

Why can't every person on the planet be as awesome as that guy? I want to set him up in a seminar in the waiting room, and have his old ass lecture every single person that comes through the doors. Man, he was awesome.

I did not invite The Todd

Three reasons why I love Scrubs:

1.


2.


3.


Enjoy, suckahs.

Ambulance worthy, for sure

Last night I sat at the computer next to the syscom-central phones, which meant I got to receive most of the ambulance reports. At about 0200, we got a call from one of the city crews....and it was a good one.

"18 year old male, was smoking pot tonight and felt disoriented and groggy, and he saw a police car go by so he called for us. Told us he thinks it was laced with something else. Patient was awake and alert on our arrival, but is now sleeping on the stretcher. Requesting no further interventions, we'll be there in three."

I asked if they offered him any snacks.

There was static for a few seconds, then the voice came back with, "nah, we didn't think it nice to wake him up."

Sigh. If only his friends had given him a twinkie and tucked him into bed, I wouldn't have had to look at this knucklehead and try not to laugh directly at him.

The worse part about this isn't that his friends will think him a pansy for calling the ambulance, and it won't be the $1000 ER bill...no, it's that his parents will get that bill in the mail after sending their dear sweet boy off to school for the first time with visions of overachiever in their heads. I don't want to be anywhere near him when that happens...

Growth

It's been 8 months since I was hired into the ER, and four months since I've come off orientation. I was thinking about this because today is the first day of college classes, and it's pretty crazy that such a short time ago I was wondering how in the world I would make it though nursing school.

I find it amazing how much I've learned in a small amount of time, but the even more amazing thing is that the more I learn the more I realize just how much I don't know.

I have gotten to the point where I don't want to vomit every time I show up for work, although I do experience the feeling of my stomach wanting to drop out of my butt more times than I care to admit.

I've had good days and bad days. On my best day so far, I handled two priority 1 vented patients back to back for multiple hours by myself. On my worst days, I've made errors, missed things I shouldn't have, and made small blatant mistakes that make me feel three inches tall.

I have days where I feel on top of things, able to anticipate and answer the docs' questions before they ask, anticipating the next orders, what the patient needs, and what to do first. Then I have days where I feel constantly behind, have no idea what to do next, and don't know what the heck the doctor is asking me to do.

I have found which staff I can ask questions of, and which ones won't laugh at me when I ask something stupid. I've found that even if the staff member might laugh at me for asking a stupid questions, it's a good idea to ask it anyway.

I have discovered which nurses are lazy, and I groan inwardly when I work with them. I feel bad for the great nurses that I work with, because I bet they groan inwardly when they see me on the assignment sheet next to them. I mean come on, I'd groan too if I had to work with me in Traumas.

Overall, I still have to calm myself down a bit when I see I'm in traumas but I feel more and more confident every day that I'm not going to kill anyone. Of course, not killing anyone and superbly treating them through a life-threatening issue are two different beasts.

I'm still in slight disbelief that this is my job, but every day I love it more and am so thankful to be working where I love.

I can't imagine myself doing anything else.

Let's just hope that I can continue to grow past the point of simply not killing someone, and one day be a great nurse.

Prank

So, the other night I did it. All on my own, with no prompting. It was a glorious moment for The First Prank.

It was about 4:30 am, we were slow, and I was looking to cause trouble. I decided to screw with one of the docs, since she's very genial and has a wicked sense of humor. So I thought back to my enlightening blog-reading, and decided to make Fake Bedpan Poo to go under her desk.

Iodine + tissue + bedpan = very real looking poo.

I enlisted the help of my fellow new-nurse in alerting me to the departure of the doc from the nursing station. Alas, she wasn't busy either and didn't leave.

Then EMS came in. And left their ambulance doors open while nowhere near the rig...Eureka!

Fake Bedpan Poo on the front seat of the ambulance is funny.

Even funnier is watching their reaction on the video feed from inside the ER.

The funniest of all is when they finally decide to pick it up, realize it's not real, and walk back inside with a mixture of fury and appreciation for a well-played prank.

***
Edit: From ImpactedNurse! Thanks, anon!

It's like I planned it...

I find it incredibly ironic that on the weekend I went camping and professed my love for it, Stuff White People Like posted this:

Stuff White People Like #128: Camping

Wild wonderful West Virginia

I went camping and tubing this weekend in Harpers Ferry, West Virginia. All I can say is this: I love the mountains!

More to follow, once I'm rested and up for posting.

Does a bear...?

Overheard today in the Trauma M&M, whilst discussing arterial injuries from a buckshot blast at close range:

Vascular Surgeon: "They teach you the five "P's" in med school: pallor, pulselessness, pain and so on, but I usually just skip all that and go right to the Charmin Test. I give the leg a squeeze and see how soft it feels."

***

And looky here, Nurse K posted this, and I just love it. So I'm stealing it shamelessly and reposting!



I hope this is me in 65 years. Except maybe with different skills. I can't play any instruments to save my life.

Dream

So last night was a hot mess, again.

Walked in to get report, and waiting for me was a vented patient with a pressure of 54/crap - asked the doc for something to counter her propofol drip but "nah, just hang some more fluid" was the response - when the day shift RN peaced out, two other patients (of mine) getting admitted, 9 admissions out of 12 rooms total (all tele/critical care) and a patient who wanted to keep coding in the room next door.

Since my patient was very close to dying but the patient next door was actively dying, all the available help went to that room. I'm sure it was mildly interesting to watch new-nurse-me run around and try to keep my patient from pulling her vent out ("just give her 1 of ativan, and up the propofol drip" [?!?]) and titrate her propofol and keep her pressure above crap and get the blood cultures and start another line and find the pressure bags and explain everything to her family and call report and everything else.

Finally, the admitting doc wrote orders for levophed, and magically her pressure shot up to 90/60 and life was good.

But that's not what this post is about.

I'm really here to tell you that I had my first frequent-flyer dream today! I dreamed that one of our oft returning nausea/vomiting/I'm pregnant patients came in with 3 of her friends, and all we had open were trauma rooms. So the four of them went into the trauma rooms, and all of a sudden we had vented patients in the itty bitty rooms, and traumas in the hallways, and codes in the storage room, but nobody would move the frequent flyers out. "They're really sick, they need those rooms!" is the response we kept getting.

It was a traumatic dream, for sure.

Scary.

1:1

Sixteen hour shift tonight and for 10 of those hours, I took care of exactly 2 patients.

Redcode #1, didn't leave the room until the patient went to ICU. Bring the dirty stretcher down from ICU, charge nurse tells me, "you're getting another one, get ready."

Maybe I'll have time to pee before they get h- nevermind. Here they are!

Redcode #2, didn't leave the room until the patient went to ICU. Bring the dirty stretcher down from ICU...sigh. Still have 6 hours left of shift.

Whew. I'm relaxing with a slice of pizza and a beer. Off to bed and then to do it again tonight!

***
And this little haiku ditty from Ambulance Driver just made my morning:

A Transfer Haiku

Demented old folks
chasing Phenergan faeries.

It's like herding cats.

Gratitude

I took care of a lady the other night who came in for a bothersome but ultimately minor complaint. After getting her pain under control she was discharged, and I wheeled her out to the lobby to meet her husband and the car. While waiting for her husband to drive up, she starts reflecting on her visit.

"You know, as I was waiting in the hall for my CT scan, they wheeled a man past me who was hooked up to all sorts of tubes and on a breathing machine and he didn't look very good. I thought to myself, 'People drive by this hospital every day and don't even realize what you all do for us.' You all are really something. I know I'm hurting, but some people are a lot worse off than I am. You all still take care of each of us the same. So thank you, for caring about us even if most people have no idea what your job is like."

All I could do was smile, say thank you, and try not to cry on her. And when I helped her into the car, she leaned out of the door and gave me a hug - and she's the first patient who I didn't automatically defer to sidehug instead.

I hope she knows how much that thank you means to us.

Somehow, I think she already does.

Certification ≠ awesome clinical skills

I'm a PALS certified nurse, huzzah.

But under no circumstances am I actually clinically able to run a ped code. Here's to hoping I don't have to do so anytime soon. Here's also to learning the skills as a bystander, as opposed to being thrown headfirst into it...

wtf moment

My biggest fear in life is drowning. But there are a few things that while I'm not exactly scared of them, they still are able to give me the heebie jeebies like whoa.

Anyway, I was working the non-critical side last night, and I was sort of busy. I got a new patient in one of my rooms, but I didn't have time to open the chart and read it through before the PA asked me to step into the room real quick.

So I pop in and the PA asks me to hold the otoscope so she can use both hands. She's got a pair of forceps, and I'm thinking the dude has a piece of cotton or something in his ear. All of a sudden, she pulls out a GIANT EFFING BEETLE from his ear. Eeeegh. I'm getting chills even typing this. Ugh it's just so gross. He could hear it crawling in his ear. Yeeeeggh.

Seeing someone who just ran their fingers through a table saw? No problem. Oops, dog bite to your shin and your bone is trying to exit your leg? Sure. Giant necrotic non-healing diabetic surgical wound? Bring it on.

June Beetle to the ear? I might pass out.



I can live without ever seeing that again.

A challenge met

"We choose to go to the moon. We choose to go to the moon in this decade, and do the other things, not because they are easy, but because they are hard...because that challenge is one we are willing to accept." - JFK



Yesterday was the 40th anniversary of the moon landing.I've blogged before about my dear love for all things space, so it was a great day news-wise for me. I'm sure you all have read the articles in the news for the past week or so, and I doubt I have anything new to add that you haven't heard before.

So I'll bring you this bit of awesome instead...

Bart Sibrel is a moon landing conspiracy theorist, probably the leading one of them all. He's made a career of stalking former astronauts and insulting their legacy at every opportunity. He'll go up to them and call them cowards, liars, and any other jibe to provoke them. Never mind that Sibrel has been caught editing the audio/visual from NASA footage for his documentaries, which makes him more of a fraud than anyone he is accusing.

Anyway, Sibrel walks up to Buzz Aldrin - second man on the moon, if you're unawares - and goes, "you're the one who says you walked on the moon when you didn't...you're a coward, and a liar, and a thie---"

He doesn't get the last word out because Buzz only had one response for him:



He decks the crap out of Sibrel's face.

And THAT is why I believe we went to the moon.

Oh, and probably also because of the endless amounts of footage, evidence, moonrocks, photos, and hundreds of thousands of people who were involved in launching the most awesome rockets ever.

Oh, and can I get a work note?

I hate giving out work notes. Like, I'd rather give myself the stomach flu instead of passing out free get-out-of-work cards. I hate all those lazy, stupid, good for nothing asstards that demand I give them whatever they want.

Usually I'm pretty easygoing while in the ER. Plenty of people have true pain, and I'm more than willing to write them up for a day off if the doc forgets to do it. But I will not tolerate the low life mouth breathers who demand demand demand.

I had a patient today who was in a very minor car accident. Natch, he was asleep in the front seat when it happened and didn't even wake up right away. Nevertheless he and his wife blow into the ER like they own the place. I knew it would be bad when the wife asked me for a phone book so she could call a lawyer. Which I didn't get her, btw.

He spend the whole time in the room bitching. Holding his arm and whining like a little girl. Whatever. Xray is negative, no marks on him at all.

I go to discharge him - after hearing him on the phone with his doctor making an appointment for this coming monday - with some muscle relaxers and motrin prescription and he blows a fit because we didn't include vicodin. I get through the rest of his discharge paperwork, and he goes, "I need a work note. I can't work with this pain." Whatever, dood. I'll give you a note through the weekend. I don't feel like arguing with your lazy entitled self.

He flips his shit. Starts with that condenscending voice, saying, "I'm the one in pain here, I need a work note for longer than that!" I tell him that I will give him a note through the weekend, but the ER does not give out long term notes. In a sweet innocent voice, I also brightly mention that since he is seeing his doctor on monday, he can surely get a note from the PCP if his injury is severe enough to warrant not being able to pull your own thumb out of your butt. Well, I didn't say all that, but I thought it.

He goes off on me, saying that I have no idea how much pain he is in, and he can't tolerate it. Mind you, he's waving his arms around like a crazy person to emphasize how much he can't move his arms. And at this point, I'm pissed. I tell him that I don't feel comfortable giving him a work note for that long, especially in light of the negative work up. He tells me that "it's not your job to feel comfortable. It's your job to get me a work note, or call someone who does feel comfortable giving me one."

I walked out of the room halfway through his rant, called up the PA, and told him to tell the dood the same thing I told him. The PA walks into the room, and in one breath goes, "We don't give out long term work notes. You can get one from your PCP. And if you continue to raise your voice at my staff, I'll have you escorted off this property. You're discharged, thank you."

He stormed out...without his work note.

Which I promptly trashed.

I sort of hope he has a major accident on the way home, and actually needs that work note.

I hate people sometimes. It's asstards like this that ruin a perfectly good night of helping people who actually need to be helped.

Slice of awesome

Jeff Lang is awesome.



Yes he is.

Happy 4th...finger dismemberment

Movin' Meat posted this, and I obviously needed to repost. Because it's awful. Fireworks and fingers do not mix, people.



Photo from Flickr

Life's little regrets

Most people have done something in their life which they regret. Like a barbed wire tattoo or an oopsie photo on facebook or forking out money to see a Michael Bay movie in theaters. I, on the other hand, regret something I didn't do.

One day in college I was hanging out with my friend Kaley, and out of the blue...well, probably not out of the blue...most likely I was rambling on about my love of Star Wars. Anyway, one day Kaley goes, "You know the guy that rode with Luke Skywalker on that snowy planet?"

I'm all, "Uh, you mean Dak Ralter, the gunner for Luke in the Battle of Hoth played by John Morton, who lives in Maryland which I know because I read it in the Star Wars Insider magazine?"

Kaley's all, yeah sure, whatever. Then she drops this bomb on me: "Yeah, him. Well, he goes to my church."

I almost had an aneurysm. A real life SW actor, at my very fingertips! I had to meet him, I tell her. It's essential to my SW fandom.


So time passes, and one day I mention to Kaley that I still need to meet him and we need to go back to that church. With one offhanded sentence though, Kaley manages to crush my soul. "I think he moved, because he doesn't go to that church anymore," she says. Egad!

All I'm trying to say is that probably my biggest regret in life is not getting my butt to that church earlier so I could meet Dak. Sigh. I think about it every time I watch Star Wars.

So John Morton, if you're out there...I'm just saying. Come back to Annapolis. I promise I won't act all weird.

***
I'm on a little SW kick today because there is an all-day marathon of the two trilogies on Spike. And I've forgotten how eye-gougingly awful Episodes I-III are. Like, they make me want to go outside, find a railroad spike, and place said spike as far into my brain as possible. Ugh, they're bad.

***
And to make this somewhat nursing related, wouldn't it be easy on the medical field if we just had Bacta tanks to heal everything?

Um, no.

Recently a guy came in for an abscessed tooth. Painful, whatever. We don't pull teeth in the ER; it's not a dentists office.

I'm trying to explain this to the dood, who just can't seem to grasp that we don't have the capabilities to pull teeth and that he needs to see a dentist instead. I tell him again and again that we don't have the right equipment for dental work, or even a dental qualified doctor.

"But why can't you just pull it now? It's going to keep hurting if you dont!?"

Dood, it's going to keep hurting if you don't listen to me and get it pulled. Oh, and brush your teeth, it might have prevented this in the first place. If you can afford a blackberry, you can afford a toothbrush.

So we run around this same question and explanation for a full five minutes, and finally the guy gets fed up and goes, "well, can I at least just get a teeth cleaning while I'm here?"

Sigh.

For whom the bell tolls

Two people had their time marked tonight in the ER.

One was quick - gunned down and left to die, he was already dead. There was nothing we could do for him.

The other will die too, but slower and much more painfully. She came in for what she thought were minor symptoms, and was admitted with the knowledge that she has widespread brain cancer.

I never knew his name. Hers I will never forget.

Hear ye hear ye

Are the police in this town walking around with big signs that say "Attempt suicide! Threaten someone! Don't take your meds!?" Because it sure felt like it tonight.

I can't even make up a sane enough story to HIPAA-fy this post. The craziness was one-of-a-kind. All I can say is that large quantities of haldol, ativan, geodon, and beefy security guards were in full use tonight. I never want to work in the psych bowl again. At least not if those same patients are there.

I'm having a beer and going to bed, dangit.

boo-boo

So I made one of my first bigger boo-boos the other day. I've made plenty of eensy ones, but this is one where a doctor looked at me and gave me the look-o-shame. The look that says, "you should know better than that." The look that makes me want to crawl under a stretcher somewhere.

A girl came in in the wee hours of the morning, and she had been stabbed in the shoulder-blade with an unknown object. When I say stabbed, I mean it was more like a small lac. I could see all the borders of the wound, and it very clearly was procured by a poorly-aimed assailant. She walked in through triage, and the nurse there took all her info and vitals and such. She walks her back to my room, and calls to let me know there was a girl who "got poked in the back" now in there. I didn't get back there for about 10 minutes since I was dealing with a more time-consuming patient. When I finally do, the girl tells me what happens, vitals are stable, I look at the wound, see the edges, and then type in her assessment. 25 minutes later the doc goes, "so what's the deal with this patient? Do I need to see her now or can she wait?" I explain how she is stable and can wait, she has a very minor stab wound over her shoulder.

Oops.

That magic word, stab, especially in the torso region - of which the shoulder blade is included - automatically means she needs to be upgraded to the most critical trauma patient. The doc does a double take at that word, and immediately goes to see her. In my head, I'm thinking "crapcrapcrapcrapcrap manI'mgoingtobefired crapcrapcrapcrap..."

We ended up only upgrading her to the lower-level trauma patient, but I learned a valuable lesson to always call the doc or charge if I'm even the least bit unsure about the classification of a patient. The doc was great about it and agreed with my assessment, and even made sure to tell me that he is always open to calls and questions about such things. Still, I felt like a bit of a tool. And just reassured myself of how new to this I really am, lest I get cocky.

But now I know. And knowing is half the battle.

Not the usual

Here is something you won't see everyday: Middle aged man found in bed not breathing, asystole for the entire forty minutes to the hospital, asystole for the first ten minutes in the ER, hey V fib let's shock!, asystole again for ten minutes, pronounce him dead after feeling no carotid or femoral pulse, asystole from two leads, everyone starts to leave the room...

Primary nurse goes, "wait a second, is his neck moving?" Feel the carotid, definitely a pulse, hold on...

Dood in asystole for over an hour suddenly decides to have not just electrical activity, but a matching - and fairly decent - pulse. I'd like to be the one to review that chart.

The worst part though is how after we drag this poor guy back from the Pearly Gates and hang the drips and vent him, we find out he is a DNR.

Unfair

I know that there is a bigger picture to this life than what I can see. God has a plan; I just can't see more than my little slice of it.

But sometimes I wonder how in the world things can happen and possibly have a meaning to them. Why, why do some things happen?

One girl can have a half dozen abortions, from six different fathers, at the age of 22, and still be able to get pregnant again.

The other girl, loving wife and expectant mother, comes into the ER full term and in cardiac arrest. Both mom and baby die, and dad is left wondering what just happened to his life.

There is a bigger picture, but dammit, I wish I could see it sometimes.

Perspective

Three years ago, I went to Europe for a week on Spring Break. It was myself and eight friends. A few of us decided one winter day that we would find the cheapest plane ticket to another continent and go there. We ended up picking Barcelona, Spain, and we planned this trip ourselves. No tour guides, no fancy hotel, no travel agent. Just 9 college kids with no parents and a suddenly legal ability to buy alcohol. It ended up being a fantastic week with no shortage of fun times.

I scrapbooked the trip this past summer, when I needed something to do on those random one-day breaks between night shifts. Tonight I pulled out all my scrapbooking supplies and found a bunch of pictures that I could use to add a few more pages. Naturally I had the TV on, and Saving Private Ryan began to play.

Today is June 6, the 65th anniversary of the day thousands died just to make it onto a beach.

It brings things into perspective.

I was annoyed at the few hours spent waiting in the German airport for our flight to Spain; many of those fighting on June 6 died within minutes. They would have given anything for a few more hours.

I was annoyed when I missed a page in my scrapbook and had to take it apart again to put in the missing page; many of those fighting on June 6 never got to send their final letters after being killed in the Battle of Normandy. They would have given anything to say a last goodbye.

I was annoyed when the water at Sitges was too cold to even put my feet into; many of those fighting on June 6 drowned when their bullet ridden bodies couldn't keep their heads above water any longer. They would have given anything to just stand on the beach.

I was annoyed when we only got to spend a few hours at Sitges; many of those fighting on June 6 never made it off the beach. They would have given anything just to live.

Every day of my life I take things for granted, become annoyed at the insignificant, and fail to keep the necessary perspective. I fail to always keep in mind that there are thousands upon thousands of soldiers who never again had the chance to take the little things for granted. It is humbling to recall those who died fighting so many years ago in a war I only know from textbooks and movies. It is humbling to know they are braver than I will ever be.


It's been 65 years. Although I often put my own selfish thoughts in the forefront of my mind, I will never truly forget those who die to give me the freedoms I hardly deserve. Thank you.

Hygenic Zombies

So do you ever have those days where you wake up and walk around zombie-like for a few minutes? With no recollection of how you got from A to B? Yeah, it happens to me too.

I work night shift, so I'm a little screwed on time schedules anyway. I've since dubbed my bedroom The BatCave since it's always blackout-curtain induced four a.m. no matter the time. Great for sleeping, not so great for waking up at three in the afternoon and still feeling like you should be sleeping.

Anyhoo, I dragged myself out of bed after too few hours of sleep today and stumbled around in my room like the undead for a bit. I brushed my teeth, I took my allergy medicine...and I got into the shower fully clothed.

You heard. Turned the water on, waited a minute, and then hopped in with tank top, socks and underwear still definitely on. It took me maybe five seconds before my brain caught up with me and I thought, "heeeyyy....this isn't right!!"

Needless to say, perhaps I should rename my bedroom The ZombieLair. At least I'll make a clean Zombie.

Iran so far

Political correctness be damned. This is glorious.



How can you not acknowledge the awesomeness of Andy with material like this?

***
Now added for your viewing pleasure. This is one of Kaley's favorite...




And this is just inappropriate...

Priority 4

When the call comes in for a cardiac arrest, everyone gets a little fidgety. When the paramedics continue and say, "but we're requesting permission to make the victim a priority 4 due to asystole on arrival with an overwhelming lack of signs of life," the atmosphere changes from we-can-save-them to one of eh-just-a-fatality-too-bad. Usually the priority 4 patients are the little old nursing home patients who just need to be let go from this world. Those people we are relieved to see go, instead of prolonging their stay with brute force.

But when the request for a priority 4 is for a 20 year old pedestrian struck by an SUV, no one is relieved about anything.

Being the clinically curious people we are, everyone goes in to look at his awkwardly broken neck, the grossly deformed lower leg fractures, and the concave skull.

Being the emotional humans we are, everyone tears up when the parents come in to find their promising young son dead on the gurney.

We can be clinically dispassionate when looking at injuries, but to see the impact that one impulsive decision will have on this family for the rest of their life...that is something that no one can be dispassionate about.

EMS

EMS is a different world, as I found out yesterday during my ridealong.

The reason I enjoy the ER is because even when we've got a hot mess coming in, we have somewhat of an idea of what sort of hot mess this will be. I know that's not true all the time and sometimes we do get completely surprised by something, but usually we have the most basic of info about someone before they roll through the doors.

Not so with EMS. I went on 3 calls during my ridealong, and each one was vastly different than the others.

Call 1: Assist for older man falling in a parking lot.

I got to ride the ladder truck for this one. Not going to lie, I was so excited; I felt just like an 8 year old who tells everyone, "I'm going to be a fireman when I grow up!"

The ambulance was right in front of us, and we roll up at the same time. The fallen guy had a pillow under his head, little nasal cannula on, and his feet propped up against the door frame. He also weighed probably 500 pounds. And oh yeah, he was blue as a primary color. The nasal cannula might have helped if he was actually breathing. The paramedics snapped into ALS mode and we started CPR in the parking lot. He was intubated (barely; he was apparently the hardest one they've had in a long while) on the way, and I got to be on the giving end of a call to the hospital to warn of a coming priority 1.

Call 2: Headache

We get to the trailer park, and the young teenage girl on the couch tells us of how she vomits every time she stands and can't speak at all because of how short of breath she is. While she walks herself down the stairs to the stretcher. And oh yeah, her headache is so bad that she can't take her headache pain or nausea pills that she was prescribed during her hospital visit the night before. She even still had her wrist band on. Gah.

Call 3: Fast heart rate

The call from the local sleep center came at 1145 pm, for a guy who was experiencing some heart problems. When we get there, the nurse goes, "oh, his heart rate went from 80 to 140." And that was the extent of the report. Mkay. We go in and talk to the patient, who was confused after just being shaken awake for no apparent reason. He doesn't want to go to the hospital, but then gives us a little history of how he occasionally feels tired and SOB, and oh yeah, feels like his heart is racing. We ask to look at the EKG he was hooked to, and the paramedic and I both point to the A flutter at the same time. He went to the hospital after we explained to him the dangers of an unstable heart rhythm.

***
In short, it was a great experience. I have so much respect for those first responders. I can't imagine going to every call without knowing what it will be. They deserve some mad props for that.

It's also interesting to see these three scenarios in one shift. We went to the first call expecting to scoop a guy off the ground and set him back on his feet, but we found someone in cardiac arrest. The second one was from a system-abuser who is hurting because she won't help herself - and we still have to transport her on the big expensive ambulance. The third guy was something seemingly unnecessary on first glance, but whom we may actually have saved a life on - he could very well have thrown a clot 2 months from now and stroked out. Instead, he got to voluntarily walk to the stretcher and go to the hospital preemptively.

I jokingly mentioned to the EMTs last night that I was scared to come into their room in the ER, because it's a big scary boys club and I felt like I didn't know anything about their job. I'm glad that I now have an idea, a greater respect for them, and some dirt on which to poke fun at them with.

Jerk

I was warned about this guy. "He's a douche," they said. "He is the biggest jerkoff on the planet," they cried. "Oh, Mr. C? He's a dick. Don't go near him if at all possible." I should have listened. Woe upon me. I should have listened. Instead, I tried to give this guy the benefit of the doubt. Yes he is a frequent flier, but he does have some serious health issues. His reason for being here today is truly something he needs to have worked on. Without fail though, he was the most massive asstard that I have ever taken care of. Snarky comments, blatant rudeness, morbid slovenliness, and an all-around bow-to-me attitude. I can handle that, though. Some people in this world are incurable jerks and there is nothing to be done for them. I can handle his douchiness up to a point. But when I needed his room for the potential respiratory arrest coming in three minutes? He retaliated by taking a crap right on his own bed while being wheeled down the hallway. I decided right then and there that if I ever had him again as a patient, I would be the worst nurse possible for him while still keeping up to standards of care. In fact, if this guy codes and dies tomorrow, I might have a beer. He was that much of a complete failure at all things humane. Thoughts like these shouldn't occur until at least many years into nursing, when I'm close to burnout. It's just so effing frustrating to see the bottom feeders of society like this guy and have to not only wipe his ass but kiss it too. The worse part is that I went into nursing because I wanted to love and help people at their lowest points and do it by sharing Christ through words and actions...but people like this make me forget all that. They make me hateful, they make me bitter, and they make me cold. It breaks my own heart to see myself like that, because I feel like I'm failing at love. Sigh. It's a frustrating situation...

An atypical drug request

Scene: One soft-spoken doctor, one rookie nurse, and one patient sitter trying to pack a nosebleed.
***
Doctor: Hmm. I need cocaine...
Shrtstormtrooper: I beg your pardon?
Doctor: Yeah, cocaine. I need some.
Shrtstormtrooper: Ummmm....sure...

Apparently requesting cocaine is a perfectly sane scenario when packing a nosebleed. Interesting. I mean, we all know I have a little bit of experience with some lidocaine, but cocaine?

I went to the accudose and typed in "cocaine" and sure enough, 4% Cocaine 10 ml popped up on the screen. I had no idea that this was a completely normal request. On returning to the patients room, the doctor goes, "Yeah my bad, I probably should have been a little more tactful. I take it you've never packed a nosebleed like this before?"

Well, color me educated!

***
And while packing the nosebleed, the doc looks up and asks me if I knew what the most common cause of nosebleeds in males was. I had no idea so, to half take a guess and half be a smartass, I responded "nose-picking?"

Doc giggled and goes "yup, digital trauma!" Who knew?
***

Lastly, there are two types of people in this world: nose-pickers and liars.

Hitting the fan

I knew last night would be bad when the thunderstorm outside was so bad it blew open and broke the ambulance bay doors then caused a hospital-wide power outage for a good 30 seconds.

13 hours later, I am so glad to be home. Good Lord I'm glad to be home.

It was rough, folks. I had drunks, patients refuse to leave after discharge, crayzees, multiple peds patients at a time, state police blood draws - for which I will have to show up in court since there was a fatality in the vehicle, very sick people, very obnoxious people, and very drug seeking people.

Crayzee. Seriously.

I might have a beer before bed, is that bad?

Swine flu

Borrowed from someone wittier than I am...

Dueling flatus

So I had my first night in mental health by myself this past shift. It was a fairly slow night, so I spent most of it in trauma, helping out with whatever people needed and then relieving everyone for lunch. Around 430 am I had an EP come in, so I rang up security and my two favorite security guards came to sit with me and the patient.

We were talking and laughing, when all of a sudden one of the environmental staff walked by and ripped the biggest fart I have EVER heard. And she weighed maybe a buck twenty. Soaking wet.

Of course, she started laughing, we started laughing, the patient started laughing, and thus ensued a thirty minute discussion on why exactly farts are so funny. Because let's be real...if you say farts are not funny, then you are lying.

At this point, one security guard pulls out his phone and proceeds to show us his favorite clip from Family Guy:



After the video, talk eventually turned to other things. At 7 am, when my relief came in, I stood up to go clock out. With all the seriousness I could muster, my parting words to the group were, "well guys, it's been a gas."

Although this one was sort of lame, there is nothing sweeter than getting in the last funny in a conversation with people funnier than I am (especially since I'm not very funny).

Unless it's hearing someone accidentally rip the biggest fart of their life.

Yes, yes he is.

MSNBC, you couldn't have said it better!

Wolverine is such a sexy beast

Losing the training wheels

Well folks, the day has finally come. The day I've been simultaneously waiting for and dreading. The End of Orientation is upon me!

It's true; tonight is the very last night of my nursing orientation. For the next 12.5 hours, I will have a preceptor looking over my shoulder for the last time. And I'm not going to lie, I am terrified. I'm excited, yes, but also terrified. It's a humbling thought to know that today I'm still training and tomorrow I'll be considered smart enough to fly on my own.

I know that I still have a ton to learn, and I think that's what is making me so apprehensive about being done. I mean obviously I can't see everything while on orientation, but I am just now coming to terms with just how much I haven't seen yet. Routine minor trauma? Sure, I'll handle that. Massive resuscitation with blood and fluids and CPR and ACLS and doctors and the Level I and everything else? That I'm still terrified of. Heck, I'm still even terrified of the STEMI since I've not done much with those yet.

Whoo. It's terrifying.

But on the upside, everyone on staff has repeatedly told me, "We won't let you fail." That is a comforting thought. And with that in mind, I think I'm ready to fly!

Yo mama wears neck ruffs...

A linky link on Cranky Epistles' blog directed me to the Shakespearean Insulter, which might be my new favorite page.

My first insult?

Thou art some fool, I am loathe to beat thee.

Thou don't get much better than that!

Sad but true

My friend Kaley sent me this the other day. I can't even deny it; I've watched the entire behind-the-scenes commentary for the Lord of the Rings extended version. Laaaame.



I mean, come on! I'm 23, have my own apartment, just bought a new car, am relatively in shape, and don't have a bunch of cats. So why am I so lame? I can't be sure, but unfortunately it is true. Sigh. Maybe I'll get some cats to cheer me up.

*Disclaimer: Cats = crazy, so I most definitely will not be purchasing lots of cats. Well, maybe just one.

Measurable difference

Moral of the story: There is most definitely a difference between day shift and night shift ER staff. ..

I started on nights two shifts ago, and I'm loving it! Overheard tonight is this exchange between docs:

Charge doc: I hate how the lab never runs our specimens on time, even if they're a priority patient. I wish we had a laundry chute that just ran from the ER to the lab, and we could drop our specimens right down onto their desk.

Other doc: Why don't we just have the patient sit their ass on the chute and squeeze out their own specimens? It'd be awesome! "Oh, that stool sample? Coming right down!"

Charge doc: I'll build that chute tomorrow if they'd let me...*mimes squatting over a chute* Sample this!!

Also of note tonight was the charge doc finding a spray can of skin-freeze anesthetic stuff, and covertly creeping behind every single nurse to spray the frigid liquid on our unsuspecting necks.

While it's true that night shift will eat you alive if you're lazy, unmotivated, or just plain stupid, it's also true that working with the night shift people is more fun than should be legally allowed.


***
And lastly, I shall include this heavenly slice of awesome for you. You'll weep most bitterly upon realizing that you've been missing out on some Jeff Lang all your life.



Ah yes, the sweet sound of auditory gold!