Speaking of lightbulbs..

http://www.youtube.com/watch?v=5ysfQjKKi70&feature=player_embedded



Compact fluorescent bulbs are NOT better for the environment:

http://www.npr.org/templates/story/story.php?storyId=7431198

Lightbulb Moments

Was going though my work binder and found some old papers I was holding onto for reference. As I looked them over I kept on thinking.."I know that.. don't need this..nope, don't need that, saw that already." It was pretty cool, kind of a light bulb moment for me that helped me realize how far I came. Sometimes I feel like I'm sort of on autopilot but what I never realized is that I am actually learning a lot every time I work.

Did I ever mention I almost joined a roller derby league? The thought of rolling around on roller skates and knocking people on their ass sounded so incredibly fun. Then I realized that my tiny little frame and giraffe legs and "little miss nicey nice" face would likely get me fucking clobbered. That and I started modeling right around when I was going to join and I wasn't sure how I was going to justify a black eye or broken nose to my agency... wasn't really worried about the pain/getting hurt angle though. I'll let you in on a little secret (that you, dear readers, may or may not already know) Gut wrenching, indescribable want to tear your skin off to get rid of the nerve endings type of pain.. that kind of pain comes with a serious high. The high of power that you overcame it and you were able to beat it. I learned about that after I had my son without any meds. I decided to become a nurse the day I had him.. not really because I felt at home in the hospital environment (though I did); but because once you make it through that intense of an experience, it changes you. Yes, I became a mother for the second time that day but I also came to realize I can do anything. People say that all the time, but, frankly, it's not always true. The world is full of posers and pussies, people who talk about doing this and that and that's all they are is talk. Push 8 lbs of baby out of your vagina, work and go to school full time while breastfeeding 2 kids, perform CPR on near lifeless bodies and try talking someone out of wanting to die when in all honesty, you can't really blame them for wanting to die since everyone they ever loved is already dead and they are basically paralyzed from the waist down. If you haven't done that, don't you DARE talk down to me.

The Night Train

Monday nights I work 3p to 3a. It's intense and most of my emotional rollercoaster events happen on that shift. While I'm emotionally preparing myself for the three days ahead, I crank up the music (the heavier the better) and clean the house (not sure why, it only gets trashed while I'm at work). As a result? I get a little bitter about all the responsibility that falls on me at home and at work. Even miss nicey nice nurse can hit her breaking point and when I do, I want nothing more than to go to a random bar and break a fucking chair over someone's head and drink whiskey straight from the bottle. Wow, imagine the shocked look on a cardiologist's face if they ever saw me actually do THAT in a bar?? lol

http://www.youtube.com/watch?v=DtFk2WJRhqw

Dear Patient,

I'm your advocate, your voice to the Doctors. I look up your labs, check them against your orders, I prime your IV tubing, I infuse vital medications. (usually it's even on time when pharmacy gets their asses into gear and profiles your shit before it comes up late on my screen). I get you everything from blankets to ice water to changing channels for you when your "clicker" doesn't work right. I clean some of you up when you mess yourself (from many orifices). I calm you down when you're upset. I teach you when you're confused. I feed some of you pureed foods spoonful by painstaking spoonful because I know if I don't feed it to you, you won't eat and I want to see you get better.

Just know while some of you complain that you are SO HUNGRY and STARVING because your dinner was delayed 15 minutes and it's 4:45p.m., I haven't eaten since 5am that morning (and you had breakfast and lunch in that time period). While your left leg is a little stiff from the rain outside I have two swollen, black and blue knees and wrists from tripping over our dog's gate.. twice. You might think I'm invincible, but I'm not. Sometimes I wish nothing more than to break my leg and be EXACTLY where you are and just be able to stay perfectly still. I could totally kick ass at that.

Beneath the stains of time, The feelings disappear.

http://www.youtube.com/watch?v=o22eIJDtKho

"I don't want to be paralyzed..I don't want to be paralyzed..I don't want to be paralyzed..I don't want to be paralyzed" "I'm in such pain, Renée, please help me, I don't want to be this way, please help me. Why can't anyone help me.."

Down by the seaside siftin sand

Working in the hospital, you meet some great people with fabulous stories. Along with those amazing stories; however, there’s almost always dark stories. A side to people that they would sooner forget about but it continues to haunt them. I think people in their 20s 30s and 40s are much more able to put the blackness on the backburner and let life kind of occupy their minds and fill their daily existence. What most of us younger people generally don’t know is that as the years creep up on you, and all the people you have ever loved disappear one by one, all those choices and mistakes you made throughout your life resurface. The worst part of replaying those mistakes over and over in your mind is that you can never change them. Maybe you didn’t realize at that time you were doing something wrong. Maybe you did realize immediately and you paid for it every day for the rest of your life knowing full well the horror you committed. It’s unreal the things patients will confess to you when they are at their most vulnerable; when the only light in the room is what filters in through from the streetlights and their heads rest trustingly on a pillow and their tired eyes look past you to the time they remember.. be it fondly or with dread. But confess they do.

And among the tales of incredible sadness and desperation, there are always glimmers of joy. Happiness in the here and now.

A perfect example of what I am talking about was a lovely woman named Marianne. I was a nurse’s aide at the time when I met her. She was a beautiful, youthful 78. Vibrant, full of light. Even in a hospital gown, she oozed class and beauty.. her hair was perfect, and had on a full face of makeup. She told me all about her years teaching dance in New York City, and fondly recounted her exciting, glamorous life to me over the course of several days. One busy afternoon, I was ambulating Marianne (she was a post op open heart patient, walking 4x a day after surgery is standard practice for best outcomes). As we were walking past the physician’s area, I saw her eyeing all the young Drs. Marianne asked me if I knew how to waltz. I answered “not really”. She responded “You will know now!” Her hands went up, while holding mine. “Left foot here, right foot there, now back, side..” we waltzed across the hospital floor (and her nurse at the time, Greg, looked white as a sheet LOL). This woman 2 days post surgery was laughing and spinning with me around the floor. The dance ended with her giving me a spin, then we stopped and curtsied and every Dr. and resident in the physician's area STOOD UP and clapped for us. Marianne turned to me and quietly said, “Now THAT, my darling is what sets women like us apart from the rest." And with that, she winked at me. :) She and I walked back to her room and she started telling me about a gentleman she once loved many, many years ago. She said he wrote a song about her that was on the top 40 and she started to sing the lyrics in the sweetest little voice. I vaguely recall it having her name in it and something about the sea, little children loving her. Since I was thinking about her while writing this, I googled what I could remember and.. well I’ll be damned, I found it! Here it is:

http://www.youtube.com/watch?v=1cuvB2XrP_M

She also told me some of her darker secrets, but I can’t share them on here since I’ve sort of identified her with that song, and I would never want to betray her confidence. I will say that she alluded to something she did in her 20s that she said she regrets every day of her life and she’s sure she will burn in hell for it and she looks forward to the day she can finally pay for what she did when she finally dies. She didn’t tell me exactly what happened but I was able to read between the lines and figure it out. She was probably one of the most complex and fascinating people I have ever met and my heart breaks for her that deep down inside, she identifies who she is as a person by one moment where she did something unspeakable. I also understand now why God is so forgiving when I think about her. If only she could forgive herself.

Another woman who stands out in my mind that I met was yet another well put together 88 year old. (you would NEVER guess her age based on the spring in her step and the wit of her words or her perfectly up to date style). She wanted to get discharged ASAP, there was a big sale at Macys and her boyfriend was on his way. LOL! I was doing her paperwork and her boyfriend showed up and kept on pestering me to get the paperwork done. So I finally get in there and she tells me she likes my lipstick. So I write down the name and brand on her med list. Her boyfriend (who looked like he was in his 60s *wolf whistle*! ;) ) Is getting more and more impatient. Then we started talked about Pandora bracelets and charms and I told her I got a charm for each of my kids on my bracelet and for my 10^th anniversary. Then she was like wow! How old were you when you got married? You’re 36, now?! Nooo” and then I told her I couldn’t believe how old she was when I saw her birth date and she put up her hand and said “Stop! He has no idea how old I am!” I said, “Don’t worry sweetheart, I wouldn’t dream of giving that away, you spry little fox, you..” and finally the boyfriend blurts out “OH MY GOD CAN YOU TWO PLEASE KNOCK IT OFF SO WE CAN JUST GO?!” LOL!!!! And not long after that we were all done with the paperwork and my little 88 year old lady gave me a big hug in her cute Capri pants and holding her mylar balloons and flowers then practically skipped away to the elevator with a guy 20 years hear junior on her arm.

Thanks to those women, and women (and even men) like them, I truly understand that age really is just a number. I might give them medical treatments and advice but the beauty is what they give back to me will carry me through a lifetime and reverberate through to every other patient I come into contact with. Being a nurse rules sometimes. :)

The 65 year spread

What an interesting bunch of patients over the weekend. A 20 yr old male with Wolff-Parkinson-White Syndrome (and cardiac conduction disorder), an 85 year old male with uncontrolled hypertension and ridiculously low heart rates at night (omg, cute as a frickin button! scheduled for a pacer placement), another 85 year old male scheduled for open heart surgery (CABG (coronary artery bypass graft) one of the 'youngest' 85s I have ever seen, a very pleasant 52 year old male with a tracheostomy who miraculously survived v-fib turned cardiac arrest (also had PEG tube in for bolus feeds and crushed meds), a sweet little blind 72 year old woman also with uncontrolled hypertension (had her on a nicardipine drip until her BPs dropped to the 90/50s from 200/100s.. drip was d/c ed once it dropped and ber BPs steadily rose THANK GOD), and a delightful Jamaican woman in with vertigo who I admitted yesterday was able to discharge today; she actually got up and gave ME a hug, not the other way around. (I'm usually the one to initiate hugs. :) )

The 20 year old was doing schoolwork on his laptop and he had an open book next to him.. in one glance I knew it was an engineering book (being married to an engineer made me very familiar with those types of oddly formatted, diagram-filled formula laden mumbo jumbo pages). I ask him what type of engineering he's studying and he says "civil engineering". He goes to a local university NOTORIOUS for drunk kids getting dragged into the emergency dept.. so I said, "Wow, it's really nice having a _____ student here without a dangerously high blood alcohol level!" He started to laugh but I could tell I he was really nervous; so I went back to the engineering talk and mentioned my husband is an electrical engineer.. now that kind of grabbed the kid's interest. We talked a bit about where my husband worked and for how long, how I met him, how long we dated... the discussion got very specific to my situation and I don't generally like telling too much about myself but sometimes that's the only way to establish rapport with someone, so I figured it was okay. Got home that night and told my spouse the story and my husband was like, "You do realize that thanks to you, that kid is pretty sure he's going to land a Victoria's Secret model once he graduates with his big fancy engineering degree, don't you?"

well, DUH


I was thinking a lot about where I want my career to go and I am still 99% sure I am destined to become a hospice nurse. The weekend program hospital money is nice but I don't think I can keep doing cardiac post op med surg for years and years. I really love the cardiac population but I never feel like I have enough time to really get to know them and support them. I do my best and a lot of pts. are very grateful for what I do give to them, but I want my job to be more patient/patient family focused. I just know I would be great at it. I think there is SO MUCH to be learned from the dying, and I think death can be a beautiful, serene experience. It's a part of life and our society keeps so quiet about it as if it doesn't exist. Honestly, the hardest part of my job is when someone dies unexpectedly.. there's no closure for the dying or their families and the patient is surrounded by total strangers usually. When the Dr's leave the room it looks like a friggin hurricane went through. Syringes everywhere, papers all over, plastic wrappers from this or that. No family ever should have to see their expired loved one surrounded by a mess like that.. so I immediately clean up the room then perform post mortem care. When the family arrives, I tell them about what the last moments were like for the patient, I relay any last words they may have spoken, then I offer to sit with the family if they wish.(they usually refuse if there's more than 1 person.) Then I pull the curtain and let them say their goodbyes.
Death is sad and final and causes such loneliness and despair for the people who are left behind, but it's also poetic and beautiful. It's the closing of an exquisite leather book cover. The reading of the story is over, but bits and pieces of it stay with those who took the time to read it. ...and bits and pieces of our loved ones stay with us because we took the time to love them.

This too shall pass....

http://www.youtube.com/watch?v=juX7VJIMsqc

I ain't no Dr's handmaiden; or, Why Grey's Anatomy is lame

For the past few years I've had to work or have class on Thursday nights so I haven't watched Grey's in years. Having watched my first episode I have to laugh at the total absence of nurses...yet they don't hesitate to pull all the patient related drama into the Dr's storylines. It's incredibly misleading because what Grey's is REALLY portraying is a bunch of scenarios NURSES would be dealing with, not Drs. A guy woke up freaking out and in pain on tonight's episode and Drs. were there to calm him down. I actually LOLed. I have never once seen a Dr. talk someone down from an emotional ledge, but I've seen many nurses do it..hell, I've even done it myself. And, in Dr's defense, they usually have an inordinate number of patients to write orders on and follow medically, so it's not necessarily the fault of a real life Dr. that they are not present for such things. After all, they can't possibly know every little thing about every patient and be there all the time... that's why they rely on nurses to be their eyes and ears. And that's also why if someone is FREAKING OUT about something, it is HIGHLY unlikely that a Dr. will be there to talk them down, contrary to Grey's Anatomy fame.


There was a big billboard up on Rte 22 about a well known medical school opening up a class for med students in my hospital. My husband saw it and said "so did you ever think about medical school?" I just shook my head and smiled and said, "Why on EARTH would I EVER want to do that? I'd lose the only thing that makes working in health care tolerable, actually taking care of people." Doctors are not caregivers. They write orders, they examine, they assess, they question. They are brilliant in their own right and I of course respect them, but the best Doctor in the world can't have good patient outcomes without talented nurses to provide care to their patients and carry out their orders as well as question those orders and bring our own pt. concerns to the attention of the physician...as well as provide emotional support. But I guess that doesn't make for good TV, so keep on with your bad selves you surgeons. I will be right over here showing patients how it's REALLY done.

Ma Teresa's joined the mob and is happy with her full time job

http://www.youtube.com/watch?v=_6nEsOE_YKk

Wanted: thicker skin and a backbone

Over the weekend I had a pt. who came in with atrial flutter and heart rate in the 160s and on a cardizem drip from a long term care facility. Obese, 2 colostomy bags, cerebral palsy in legs, slightly MR, very needy and impatient. But, I have kids, I know how to talk calmly and sweetly enough so he doesn't get too upset. Often, all he wants is his nasal cannula adjusted or a pillow under his ankle anyway. Maybe some toast and a sip of water. So basically, when he's my patient, I'm the only one who goes in there when he calls because the aides just have no clue how to handle him. Fine, whatever.
When I got him back yesterday, found out his heart rate plummeted into the 30s that afternoon and they d/cd the cardizem drip and started him on a dobutamine drip. I recall during my ICU rotation a few of my pts running dobutamine, but I couldn't remember anything at all about the drug (honestly I didn't think we were allowed to run dobutamine on our floor). All I knew was if his heart rate went over 100 I was to shut it off. (no titrating, just turn it off) Alrighty then. So I'm doing my assessment and thinking, you know, if anything happens to that site, I'm fucked. I better try to get another peripheral site into him. I tried and I couldn't get him. Called the charge nurse, he couldn't get him. Grabbed a Dr. and told him we need a PICC line placed in him by the PICC team. Dr. put in for the PICC team consult and they will be in to place the line tomorrow am. Perfect! Now all I had to do was protect that site with some extra gauze and cross my fingers nothing happens to it.
45 minutes later he hits the call light and says, "I think my IV site is out"

FUCK.

Go in the room, sure enough the site is out. While I'm assessing the site, a priest walks in to give him communion and I'm thinking to myself "well good thing you're here, we may be needing last rites, too.."
Page the Dr. and tell him the site is out and the pt. is not getting his dobutamine. He tells me to page general surgery and have a central line placed (a little riskier than a PICC insertion but he needs the medicine and it's well known he's a tough stick). Get in touch with general surgery and the Sr. resident says, "Have you exhausted all your other resources? Called ICU units to get a peripheral site put into him? A central line should be a LAST RESORT and it sounds to me like the only reason you are asking for a central line is because you don't have the skill set necessary for this patient's needs. Keep calling other floors and if no one can get a line in the next 2 hours we will come and place the line."*slam*
I stood there stunned for about a minute and ran though about 5 scenarios in my head.. most of which ended up with my patient coding because I wasn't able to get him the help he needed in time... and I cried. I stood there right in front of the printer by the front desk and cried. Charge nurse (G) saw me and said, "WHAT DID HE SAY TO YOU? What's his number? I am calling him now.." I begged G to just help me get a the pt's dobutamine into him and we can talk about the resident's communication techniques later. I was more worried about my patient than my pride. In the midst of my crying, the priest came over and asked me if it's ok if the pt. received communion and I said yes, it's fine. (The priest looked kindly concerned for me and told me he's sorry I'm upset and he will pray for me, that was very sweet of him.) One of the nurses from our floor was able to get a line in him after all and the dobutamine was back up and running. Who knows, if not for the priest maybe things wouldn't have resolved so quickly.

Anyway, the better part of today was spent in tears, partially from exhaustion, partially from stress, partially from sheer loneliness. I hate that I internalize everything and things affect me so deeply. I can feel my healthy life perspective slipping away from me, it's getting more and more difficult for me to process all the complex scenarios (this story one simply one of MANY). All I feel left with is raw emotions and an inability to cope with them. Giving all you have to complete strangers for 12 hours a day 3 days in a row is exhausting emotionally and physically. The odd thing is, while I'm at work, for the most part, I feel invigorated. I kind of view my patients as a gift, I'm so lucky I get paid to do what I do. The downside to that is, allowing my heart into the nursing equation I think will eventually become my greatest mistake. When you give so much of yourself, you risk losing much of yourself. I hope time teaches me how to balance my emotions because if I continue on like this I'm going to suffer tremendous consequences.

Sometimes I wonder

if I'm really cut out for this.

GET THEM THE DAMN SODA

There's a new trend in hospitals across the nation. The trend is a goal of meeting and exceeding patient (and family's) expectations. (There are other trends regarding payment/reimbursement issues and hospitals not getting paid for hospital acquired infections/pressure ulcers/etc.- but I'm not discussing that today) The problem lies within the perception of what that mentality means to some nurses. There are many nurses who resent this pendulum swing into more "customer focused" type of care.. nurses who feel that they are above taking dinner trays away or getting a cup of ice water because "I didn't go to school for X amount of years so I can wait on people hand and foot." Nurses who are hell bent on being the one in charge and telling the patient to do things because they are In Charge and You Will do What I Say.

Nurses are highly trained professionals with an enormous amount of skills and who need to be able to think critically, have a solid knowledge base, be able to delegate as well as coordinate care from many different disciplines. It takes time to master all of that and it's something to be proud of for sure, but once you start thinking all those things make you "better than" having to do little things for your patient too, I have one thing to say: Get over yourself.

Your patients are scared. Maybe from lack of knowledge, maybe because they saw family members die in the hospital, maybe because of a fear of the unknown-- there's a million things that can scare them. Your patients are frustrated. 10 Drs tell them 10 different things and they don't understand 50% of what the Drs are saying because the patient is so intimidated. Their health is in jeopardy, they are facing their own mortality in a lot of cases... and some nurses will get upset because they asked for a diet soda. REALLY? Well, let me tell you what I do. I get them their damn soda and I ask their family members if I can get them something while I am in there. It's the least I can do. Look at the big picture. You are healthy, perfectly capable, and compared to the patients you are caring for, you are in a pretty good place... GET THEM THE DAMN SODA.

If you have a diabetic looking for laffy taffy, yes, you can say no and explain to them why you can't give them candy because it will affect their health badly, but if they want, you can get them sugar free yogurt, ice cream, etc. But I will tell you something else.. if I have a 96 year old man on a cardiac diet who hasn't been eating because he doesn't like the food and his son brought him in a doughnut? You bet your ass I'm going to let him have the doughnut. He's 96, for christ's sake, let the man have his damn doughnut! I believe that there's a lot to be said for life's little pleasures boosting a patient's morale and give them something worth living for.

I can go on and on with examples but my general rule of thumb is this when a patient asks for something, "Will it really hurt? If so, what's a better alternative to offer? If it will benefit them by making them more comfortable (pillow, blanket, water), just GET it- if at all possible, right away. A patient won't remember if you gave them their lopressor at 2:13pm but they will definitely remember if someone walked by their room and thought they looked cold with just a sheet on and put a blanket on them... that reminds me of one of my favorite things about working overnights. When all my patients are asleep and I am peeking into their rooms I always think to myself that they were someone's baby at some point and how lucky I am to be able to be able to watch over them like someone once did, sometimes almost 100 years ago. Nurses need to remember it's a privilege to be able to care for patients, you are not doing them a favor, you are simply doing your job- and if you are doing it well you are taking care of their body and their emotional well being. THAT is the heart of nursing.

Goodnight, sweetheart

I've had a miserable, emotional day and I am beyond exhausted so this entry will be brief.

Three peaches guy passed away last week. One of the nurses heard about it and told me since she knew I had bonded with him. (I wish I had known sooner because I would have gone to his funeral.)

I hope they played the 1950s music at his funeral that he wanted... but on the off chance they didn't....

This one is for you, Stephen. May we meet again someday, my friend.

http://www.youtube.com/watch?v=egX9N8yOgaU

Sleep

I wish I had some.

The best of the best and the worst of the worst

Well, the Big Guy is at it again.

I literally see hundreds of patients a year.. but it just so happens that the very patient who prompted me to create this blog was mine again over the weekend. :) This time it was just to have a dialysis port put in. He remembered me and that fateful day he had a rapid response. It turns out he coded a few days after that when he was in the ICU and they were able to bring him back. He also remembered what an asshole that Dr. was who didn't want to help him when he knew he was in trouble. He actually filed a complaint against her. (*clap* yay for him!) One thing about nurses is while we tend to stick together with each other and Drs. in the teamwork sense, good nurses are patient advocates above anything else. He also thanked me for listening to him and for staying with him when he was scared he was going to die. Three Peaches guy told me all about his time in Vietnam, how he enjoys fly fishing, and all about his family. He also told me he loves 50s rock and roll and at his funeral he wants that kind of music playing and how he wants his life to be celebrated when his time comes. I'm so glad he had the time to think about those things and to share his thoughts with me. It really helped the whole nursing experience come full circle for me to be able to get to know him like that. :)

And now for the worst of the worst...(if you think I'm some sort of nursey angel, prepare to be very disappointed. LOL)

Guy in his early 30s with a trach. I guess he had throat cancer or some kind of shit. I don't know and I didn't have time to read his chart thoroughly, and frankly? I don't really give a flying fuck why the trach is even there. He's on Q4 hour 2mg dilaudid, enough god damn benadryl to put down a fucking horse, and the max dose of ativan. Fucker should be high as a god damn kite and instead he walks around the unit pushing his IV pole around, looking in everyone's room, listening to everything that's going on, asking nurses questions about other patients (helloo HIPAA violation!), and basically following me around annoying the hell out of me.

So I was going around checking on all my pts. (I had 6, as usual) and I notice my frail 94 year old lady's color looked a little off and she was shivering. Temp: 99.8 Took out my little pulse ox (just bought it on amazon for 70 bucks) and it showed 75% on her finger! whaaa? noo that can't be right. Put it on her big toe.. 76%
oh fuck. Bump her up to 6L (she was on 4) Grab a hospital grade pulse ox: 75% Page respiratory. Blood pressure: 122/76 heart rate 136 (normal sinus cardiac rhythm). Grab charge nurse. He says to page her Dr. before calling a rapid response. Dr said see what respiratory says and if they think she needs a rapid response, call it. (Honestly, if the charge nurse were not there I just would've called a rapid response right then and there. Rapid responses are meant to prevent code situations and I had an awful feeling we'd be calling one.) Respiratory put a mask on her, got her up to 95%. I grab an automatic BP cuff and set it to check bp every 30 mins., and continuous pulse ox monitoring.
Then I look and see trach man is standing right outside the door. "Hey is she going to be okay?" I answer, "I'm doing my best to help her be. You doing okay?" (note how I did not say "can I help you with something?" lol) He says, "I can't take this pain anymore from this trach, I can't sleep one more night with it in, I'm going to take it out!"
My response, "Don't take it out, you won't be able to breathe. I will page the Dr." My response was calm because, frankly if he had ripped his trach out, I would have prob watched him for a few seconds, blinked, finished what I was doing, then casually looked at my phone for a few seconds before calling respiratory for the guy who was about to collapse in about 30 more seconds. Not that I believed his threats to take it out anyway.

Dr. calls back and I tell him what's going on and he says, "I have 3 traumas I can't see him right now, I know this guy and if I go in there I will be stuck in the room with him for an hour. Tell him I will have ENT see him first thing in the am to address all his concerns. So I tell trach man this and he throws a tantrum. "Why won't he see me? THAT'S IT! I'm taking my trach out!" DUDE, you have the fucking trach for 6 months and all of a sudden NOW you can't take it anymore? Seriously? Fuck you, you needy little bitch. (Kind of reminds me of a toddler acting up when the infant gets too much attention.)

Page the Dr. 2 more times and he doesn't call me back. Finally after a third time he calls me back. I tell him trach man wants to rip it out and he's very upset. Dr tells me he's still busy, I say, "Can't you send a resident?" He says, "Oh they won't be able to handle him, they are all too new." *pause* then I said, "well are there any you don't like?" It was at this point the Dr. started laughing and said "okay, I will be right up." Then trach man's wife called, so I did what any good nurse would do. I tattled. The wife called to ask me if he was in his room yet because he's not answering his cell. Then I said he was going in the room now because the Dr. is coming up to see him. Then I explained his pain and the trach, etc. and that I am just warning her he might be upset when she talks to him but that the Dr. is on his way. Wife says, "Oh he always does that. He's like a little kid. I love the man to death but he's addicted to dilaudid, and he's very attention seeking. I feel so badly for you nurses who have to take care of him. I know how he is, I will try to calm him down when I talk to him, thanks for letting me know how he's been."

I found trach man and told him to go back into his room because the Dr. is coming up to see him. Then trach man says "my tongue ith tharting to thwell" if it were anyone else I'd be freaking out but by this point I knew he was an attention whore and he was exaggerating/pretending and I had to get back to my lady. So then I told him to mention it to the Dr. since he was coming right up and that he had his limit of benadryl so the Dr. will have to write a new order for it.

Dr. orders an extra dose of dilaudid and an extra dose of benadryl and puts the guy on cardiac telem for overnight so we can make sure he doesn't overdose. 45 minutes after the aide goes in to check vitals he says, "I need a sleeping pill". Oh yeah, RIGHT he's already maxed out on dilaudid and benadryl lemme give him a sleeping pill. LOLOLOLOL I go into the room to give him his IV bag of omeprazole, he says nothing about a sleeping pill to me. THEN 10 minutes later he hits the call bell and says "Where am I?" "aide answers you are in XYZ hospital" then he says "Why am I here?" she said "your nurse will be in"
Okay Mr. Attention whore, you've just given me just the right ammo. I walked into the room, said "Are you feeling ok?" he says "oh I'm fine except...*frowny face* I can't sleep. Can I have a sleeping pill?" So I said "Oh heavens no! You sounded so confused a few minutes ago when I heard you asking where you were over the call bell, it would be irresponsible for me to give you any more meds! You're already over the limit on 2 things!"
That's right motherfucker, you and your biiiiiiiig mouth.
Doesn't he then call 10 minutes after that looking for ativan? My answer? Still NO.

130am rolls around.. 1 hour and 45 minutes to go until my shift is over.. asshole calls AGAIN.. "when can I have my dilaudid?"
I knew damn well he was due at 200am but I was running out of time, plus he had an extra dose in him from bullying the Dr. a little while before. I still hadn't charted my assessments, hadn't done any chart checks.. I had a ton of shit to do and I was going to be DAMNED if I was going to be there one fucking minute past my shift.. 12 fucking hours of this asshole was ENOUGH.

When is your dilaudid due?
0315am motherfucker. That's when it's due. So I actually told him 0315am.

I love caring for people and helping them but it royally pisses me off when people try to manipulate me and compromise the care of people who REALLY need help. My lady who had the low 02 sats made it through the night- no thanks to dipshit. It's only by the grace of God that poor lady didn't end up going to the critical care unit that night because thanks to him, I wasn't able to watch her nearly as closely as I ordinarily would have. And now on top of everything else I get to feel guilty because I'd love nothing more than to kick one of my patients right in the ass.

Sometimes being a nurse just sucks.

Quick Update! :)

Three Peaches guy LIVED! He went home with his family last Sunday. :)

Seriously talented boobies

Had a hilarious patient over the weekend. She's a woman in her 60s with a mean streak a mile wile and a mouth like a trucker. I think she might be a lesbian too even though she's married. She told me she married her husband for his health insurance and he's an abusive a-hole. (case management is following up with her) The reason I think she might not be straight is because pretty much from the time I enter the room until he time I leave all she does is talk about how I look, and when I give her a shot or anything she says stuff like "sweetheart, with a body like that you can do whatever the hell you want with me!" It's way creepy, but I'd rather be on her good side than her bad side so I just blew off her comments.
So anyway, she was coming back from an echocardiogram and the transport guy and our matronly nurse's aide who looks like this:

were helping her get off the stretcher. (actually the nurse's aide looks EXACTLY like the old lady on the one Beavis and Butthead movie where they are on the plane and the little old lady gives candy a.k.a. caffeine pills to cornholio, but I couldn't find a pic of her :( ) Anyway, she was helping the trucker mouthed pseudo lesbian off the stretcher and the aide called me to "get in the room QUICK, and look at her IV" I went in and her IV was pulled out. The trucker lady pointed at the aide and said, " She brushed against me and her goddamn TITS ripped my IV out! You oughta get those things licensed as lethal weapons!" I thought the aide was going to 1. die of embarrassment 2. wet herself. (always a distinct possibility, as I overheard a rumor she actually does wear Depends just today.. well poise pads, but still.) The only person laughing harder than the rest of us was the poor man who was pushing the stretcher. Every time I saw him for the rest of the day he just kept on shaking his head and laughing every time he glanced in my direction.

Why Three Peaches?

I think most people are born with a sixth sense about things. Things happen, occasionally our instincts are wrong, and eventually we stop listening to that inner voice. I, however, am stubborn. And when I am right, I am RIGHT. If I'm unsure about something; however, I am the first to admit it. This past Sunday morning I knew something bad was going to happen on my way into work. I have a tendency to internalize a lot of what goes on around me so I think that God gave me that extra sense in order to prepare me for the big things in life. So on my way in to work I turned up the music and let the sun warm my face through the car windows and said to myself "whatever happens, happens. I can handle whatever comes into my path. I am READY."

In report, I get the details of a patient who's been vomiting for the past few hours. He has several cardiac blockages, has a history of non q wave MIs (heart attacks that don't show up on EKGs in a typical manner). He received Zofran at 0600 and he's been vomiting frequently ever since. The night nurse told me she paged a resident and the resident told her they don't want to change anything medically at this time. So he continues to vomit without explanation, he continues to suffer with no relief. UNACCEPTABLE. His was the first room I stopped into and upon seeing him I decided right then and there I was, in no uncertain terms, leaving him until he felt some relief. I never saw someone so violently sick after having Zofran, my gut told me something was just not right. I page the resident and explained I knew they told the other nurse they didn't want to change anything medically but it's 0715 and he's still very ill and needs to be seen. Resident orders compazine (another IV anti emetic) and then it's just a matter of waiting for pharmacy to get the med into my desperate hands. Throughout all of this I am sitting next to the patient, asking questions, reassuring him..at this point he says, "I'm in congestive heart failure, please get me help!" I grab the resident and she comes in and listens to his lungs and hears the same bilateral crackles I told her about and she turns and turns off his IV fluids and says, "he's a little overloaded, he will be fine". If WTF had a facial expression, surely I had it right then and there. Then she said, "Well what else do you want me to do?"
REALLY?
Well, SHIT. All I have to do is turn off the IV when someone is having a heart attack? Someone call the American Heart Association and tell them they are ALL CRAZY for all that CPR bullshit.

So I called a Rapid response. I went right over that apathetic bitch's head and guess what? By the time they got into the room he was completely unresponsive.. but he still had a heartbeat, god damnit. His O2 sats were crashing. Respiratory put him on an O2 rebreather mask. Sats still dropping. His lungs were filling with fluid. I pushed 80mg of lasix, the CCU nurse inserted a foley. His extremities were mottled..I pushed 1 mg of morphine then another mg of morphine. Respiratory intubated him. His eyes were glassy and fixed on me. The tube keeping him alive held in place with what appears to be a gag. The man I was conversing with and comforting 10 short minutes ago would surely have been dead at this very moment had I not gotten him the help he so desperately needed. He was on his way to the critical care unit. Away from me.:( Why did I feel like I failed him? When I brought this question to my boss she asked me simply, "Did he code? Did his heart at any point actually stop?" The answers were no and no. She told me I got him help before he coded. I prevented a code- I did not fail him at all.. I helped keep him alive.

After he was gone, I was gathering his belongings to send downstairs to him. Dentures (I added an efferdent tablet.) A watch, some nice pens, clothing, and three peaches. Logically, I knew he wouldn't be eating them. I probably should have thrown them away..why was I even worrying about these peaches?? But what if his family wanted them? What if tomorrow morning he's extubated and feeling really hungry for a peach? Throwing away those 3 peaches meant I was giving up hope for him and I wasn't ready to do that. Personal belongings list, item #5? 3 peaches. You bet your ass.