Sometimes I swear I have ESP

So, two weeks ago, had a lovely lady patient, post open heart surgery who was ready to go home.  It was the first time I had met the woman and I was discharging her and her husband was very vocal about being upset about the care she received because- primarily, she wasn't washed. (sometimes when patients are considered a "self" the aides assume the patient gets themselves washed up, and they don't bother to ask.. it's yet another thing the nurse is supposed to follow up on and make sure has been done, but in the daily chaos sometimes gets forgotten.)  SO while I am talking to the husband and trying to make things better I had a sudden flash in my mind of him in a hospital gown.  I had a distinct feeling that I needed to make things right for him and his wife.  So I did the d/c instructions, apologized for the things they weren't happy about and assured them that I would let my manager know they were displeased about the bathing situation. The husband kept on saying "XYZ hospital sure has gone downhill.." and I specifically drew out of him all the examples of why he felt that way and addressed each one and did my very best to fix what I could and told him I would tell my manager about what I couldn't make better right then and there.  Then, I couldn't find a nurse's aide to take them downstairs, so I gave her a ride downstairs personally, and wished them both well.

So last weekend I was looking over my patient assignment and lo and behold.: there was the HUSBAND'S name on my patient list.  Turns out, three days after he brought his wife home from open heart surgery, he had a heart attack and fell down a flight of stairs. He was bruised pretty badly, but thanks to a stent placed in the cath lab and lots of pain meds; he was feeling okay.  He saw me walk into his room and said, "THANK GOD IT'S YOU! I was just telling my wife on the phone I was hoping I would get you as my nurse! You're the best damn gal in this place!" I was his nurse all three days last weekend and it was pretty great.  He hated everyone there except for me... he reminded me a lot of my paternal Grandmother for that. lol    All in all, not a bad weekend.

But I still can't wait to get the fuck out of there.

Well slap me on the ass and call me Sally.

Got home from work a little while ago.  That guy with the little girl?  He is talking SO. MUCH. BETTER!!! He had a general consent form that had to be signed and he SIGNED IT with the hand he was barely able to move yesterday.  HOLY SHIT! :)  Then you know what he did? He signed it AGAIN. and again and again.  The paper was covered in his signatures.  I felt like I was teaching elementary school again when a student had a "light bulb" moment.  I can't tell you how HAPPY I am for him. ♥

Let me tell you a little something about stroke patients.  Usually they have a LONG road with a lot of work ahead of them, and that's if they don't die first. The reason why it was so hard going from being a cardiac RN to a stroke RN was because as a cardiac nurse.. we make things better.  Oftentimes in the case of a stroke, we basically watch patients get sicker and sicker and are powerless to do anything to stop the progression of the stroke. (just to clarify, the clot busting drug tpa, if administered within 2 hours of stroke symptoms can actually reverse the effects of a stroke and it is MIRACULOUS.  That's why the stroke campaign says "time lost is brain lost". Very rarely do I see patients get to the emergency dept fast enough to benefit from the drug, however.)  Anyway, since we started getting the neurological patients, it's been very overwhelming for myself and the other cardiac nurses because now? we can't make things better like we used to.  Heck even when I had a patient on hospice care, I had a sense of making things better by virtue of being able to be there for the patient and family. There CAN be a good death; a happy, dignified passing surrounded by love.  A stroke is frequently devastating to patients and to families and it robs them of goodbyes and the person they knew long before the body gives out.    So when I see a patient with resolving symptoms? It makes me very VERY happy.

Why does Christmas always have to suck in the hospital?

Well, the good news is: the computers worked this year.  The bad news is we got INUNDATED with stroke admissions. Typically Christmas goes hand in hand with heart attacks and congestive heart failure (hellooo sodium on sodium restricted patients..) so I was rather looking forward to some nice patients with chest pain, ST changes and elevated troponins.  Instead I get a 47 year old guy who got hammered and was found unresponsive by his wife and who was unable to move his right side or speak intelligibly.  This was all initially written off as alcohol related until his blood alcohol levels dropped and his speech did not improve. In listening to his speech it wasn't slurred exactly, it was definitely more of an expressive aphasia.. more specifically of the Broca's area of the brain.  He was transferred to me from a smaller hospital and when he got to me I could tell he was really REALLY scared.  But he wasn't able to speak very much.  I took my time in talking with him and he said to me "Is.... th this... tem.. tem..por..ary?"  Honestly, I didn't know, but I HATE giving bad news, and truly, as long as he didn't have another stroke he should be able to be rehabbed back to almost where he was before. I responded "I have seen patients with your same symptoms recover fully. The key is that we treat you so that you do not have another episode like that and have further damage.  That's why you are here.  We specialize in TIA/strokes (assuming that's what you had) you are in exactly the right place."  I could see his expression soften.. he reminded me of my boss at the body shop years ago when I worked there as a CSR/admin. Very tough guy look, big, tattoos all over, but with a very distinct kindness and vulnerability about him.  "Can.. I.. wa..wa...watch some..foo..foot..ball?" I put on the game and walked out.

Minutes later, his wife arrived and I was running around like CRAZY.  I was so far behind, I snapped at a float aide (she REALLY pissed me off), and I kept trying to get back in to talk to the wife but I spent so much time with the husband, I had to get caught up with other things first.  Then I noticed a little girl, about 5 sitting by his bed crying.

I went in and introduced myself to the wife and taked to her a bit about the fact that he needs an MRI, we don't know if it's a stroke yet, but if it is.. etc.  Then I looked at the little girl and said, "Is this your Daddy?" She sniffled "yes... Can he please come home with me and spend the rest of Christmas with me?" "I'm sorry sweetie he cannot.  He needs to be feeling a little bit better first. The doctors want the nurses to watch over him for another few days so that he can get better first. He's safe here, honey. We will take good care of your Daddy."

I am praying SO HARD that he didn't have another stroke while I was at home.  Guess I will find out in a few hours when I go back from 3p to 3a.

I got it :) I GOT THE JOB!

Still have to do some extra paperwork type things, and my official transfer date has to be ironed out with my current manager, but I am officially the employee of a hospital that is only 11 minutes from my house.  I'm nervous, excited, happy, and scared.. but I'm mostly really excited.

I had an extremely difficult assignment over the weekend-especially Monday. I skipped a lot of meals the past few days and I have been under a lot of stress. I had a few month run where I felt like I had everything totally under control but lately, as my patient load becomes more and more heavy and the patients become more confused, I'm finding myself being so unhappy.  (as is reflected in my blog)  I did have some high points this past weekend I will try to talk about at a later date.

One final thought...

STILL WAITING

This delay is not very encouraging, and is annoying, quite frankly.

Oh yes he is

Wake me up at 5 am to bitch about how the freezer door popping open overnight and how I have to pay for it and how it's SO BROKEN, blah blah blah..THE SKY IS FALLING THE SKY IS FALLING.. this becomes your theme song for the day. I will hum it in your presence throughout the day over dinner, and during the evening.

I'm married to him

P.S.- the fridge is FINE, Chicken Little.

Nothing yet... How WILL I pass the time..

Oh look, I'm doing stand up comedy! But I'm sitting on my ass!

Since I am anxious and need to keep my mind occupied, I'm going to talk about ordinary things.  About nothing type things.  Things that could easily have been addressed on Seinfeld had they ran a few more seasons.


Macaroni and cheese boxes.  Whoever came up with that pathetic little perforated "D" shaped arch that says "simply press here" is a piece of shit. What it should say is "jam the butt end of a butter knife here".

Electrical outlets are supposed to look like little faces.  Two eyes and a mouth. Anything else is upside down.  Whoever installs said outlets in this manner should be doomed to the circle of hell in Dante's inferno where all the Glade plugin air fresheners are upside down and leaking all over and shit. Then they have to clean the ensuing oil stains.  Forever. 

Why are there so many houses and businesses that have the hot and cold water reversed? Is it that hard to 1. check after installation and 2. change around if it's not right?  Does an exposed ass crack really predispose people to a life of the inability to differentiate between hot and cold?  You know, the weather has started getting awfully chilly.  Clearly I need to let my ass hang out.

Why is it called a Driver's License and not a DrivING License? You can have a nursing license, a hunting license, a fishing license, so what's the difference?  I'm also not sure why people from New York have licenses at all except maybe to keep track of who send all the fines to.

And finally, why can't Victoria's secret come out with a pretty bra with wide shoulder straps? Not everyone is flat chested like their models. They should also have a breastfeeding and maternity line, since wearing their little carnivals of naughtiness end up getting women knocked up eventually anyway.  It's a whole untapped market, as far as I can tell.  (Though I suspect VS really markets to the male population, as my 8 year old son's horrifying-to-a-mother's  secret stash of catalogs can attest.)

Tick tock

Please please please phone, RING! I WANT THIS NEW JOB!

Interview Complete

I think everything went well and the interviews were so easy.. why?  Well, they asked me to "give examples of a time when xyz happened.."  Helloo? They ASKED ME for stories. That's like asking arsonist to throw a match into the shredding bin. My arms flying around appeared to be a little distracting; but the various people I interviewed with were so busy trying to contain their laughter and looking down at their pretend papers, my flailing upper extremities probably weren't as apparent as they actually were.

So either I will be informed I have a new job in the next week or so OR I will be hauled off my current hospital floor in 4 point locked restraints and sent to the behavioral health unit.

Whatever it takes to get rid of that Monday shift...

You ain't foolin anyone, k. d. lang

Just when I thought I had seen/heard pretty much everything... in enters the drug seeking, multiple body pierced, tattooed, butch lesbian.  (She really did look almost identical to k.d. lang)

Came to the hospital with symptoms of a tumor in her brain and a story that she has a diagnosis of  some obscure brain tumor name that escapes me at the moment, but she states she lost her health insurance last month and was hoping to put off treatment until she has insurance again.(as if insurance would pay for a pre existing condition, but I digress) She was admitted to my floor because she was presenting with neurological symptoms such as severe headaches, obvious dilation of left eye- and an incredible "need" for IV dilaudid.

The patient went on and on to everyone about how she chose our hospital because we provide such "great care" and was, in general,  very pleasant. She was very odd in some of her behaviors and requests, however. Not that it takes an extraordinary amount of clairvoyance to notice she was "off", but my gut was *screaming* to me to watch EVERYTHING when in there with her. Unfortunately, that particular day the state was on our campus and for routine health inspections and a REALLY big no-no is to keep a saline flush stocked in your mobile computer (it's considered a medication), so I gave her some dilaudid (by the way, you are supposed to give dilaudid-- or any narc, slowly, over 2-3 minutes so as not to 'shock' a pts system.. or give them a head rush.. she ASKED me to push it quick. RED FLAG NUMBER 1!!) and reached for a flush and realized I had no flushes on my computer. DAMN.  Went out and came back seconds later and she said "I think my IV is leaking, I didn't get all my medicine.." oh SURE you didn't.  She obviously tugged at and loosened her IV after I walked out of the room and put a few drops of water onto her arm.  But I couldn't accuse her of that without actually seeing it.  I called the resident and told him I think she got about half her dose but that I was a little suspicious of her tampering and documented it as such.  The resident ordered her an additional half dose but I waited until she called and asked for it to give it to her.  I was EXTREMELY annoyed not only because she was quite obviously wasting my time, she was taking away from my other ACTUALLY SICK patients.  (Do I sound harsh? ..read on)

Then she kept on telling me about how she is a "crappy stick" and usually gets a PICC line placed when she's hospitalized. (a central line that you can draw blood from and put meds into. God only knows what the hell she wanted to inject into that damn thing! ...do I still sound bitter?  Well, read some more)  After that, she asked me if I could leave a saline flush in her room so she can use it for her contact lenses. More red flags raised in my head.. 1. as I mentioned, saline flushes are not supposed to be left on our computers; therefore, they CERTAINLY should not be left in rooms! And even more certainly not for patient use! 2. Christ on a cracker, CAN YOU IMAGINE WHAT SHE WOULD TRY TO MIX INTO THE SALINE AND INJECT INTO HERSELF?? 3.  She kept on sneaking outside to smoke.  I told her it is against hospital policy and it's not safe for her to be out there, but she kept on going out anyway and stating "what are they going to do, kick me out?"  I took careful notes on ALL of these requests/demands/behaviors and put them into the computer.. doing so actually helped the residents piece together a very significant finding, as well... (a lot of these things are classic manipulative/drug seeking behaviors)

 All the aforementioned suspicions occurred to me before I found out the not so shocking finding... her MRI was absolutely NORMAL-- which means she was FAKING all her symptoms and was likely using dilating eye drops (probably that she stole during a routine eye exam.. think of how many times they leave people alone with those drops at the optometrist's office while waiting for a Dr. exam).  The Docs were PISSED and immediately discharged her and told her basically to "get out". 

Sometimes people are such assholes.

Ok.. Patience was never my strong suit. ;)

I officially applied to the new hospital location for a Saturday and Sunday only weekend days position. The floor I applied to is not open yet, so realistically it might not be until January that I officially get to start,  Assuming I get the job, but I really don't see why I would not.

 It's pretty clear to me that I need a change and that what I am currently doing is NOT working. So, true to form with me, I'm fixing it. I'm also really excited to be a part of a brand new hospital that is ten minutes from my house. And the people I know that have transferred there are awesome. Many, many thousand dollar a year paycut aside, this is going to be epic! :)

Keep going back for more

Nursing is a really weird thing. It’s the most rewarding and yet the most stressful experience I’ve ever lived though. When I’ve got intense, high acuity patients (which lately is all the time on my floor), I have a tendency to push all my own needs to the side and give my all to my patients. Most patients recognize it and some even appreciate it, but on the extra busy days when I don’t sit or eat or drink for 13 hours, I find myself in tears the second I get into my car. And driving home. And in bed. And in the shower.  I think my biggest problem is, the more difficult and needy my patients are, and the less help I have, the more I ignore my own body.  I know that sounds crazy and counterproductive, but I get in this “zone” where all I think is “maybe I haven’t eaten in 10 hours but this patient is experiencing a worsening stroke and I have 5 other patients besides him- they win priority.” My thought process is that I might be hungry, sore, stressed, whatever but oftentimes my patients are dying or nearly died, confused, tearful, scared, etc. and that is more important for me to address than my own needs. It just is.  It’s what drew me in to nursing and what I fear will eventually land me in a psych unit.  And as much as I know this job is destroying me, I know I will never do anything else.

It’s very much like being in an abusive relationship.

I need to find a better balance.  My plan is to drop down to 2 twelves every week vs 3 twelves, but right now I need to prepare financially and build up some savings for me to be able to do that. I also am going to try and get into the new hospital location that is only 10 minutes from my house. My goal is to achieve this within 6 months to a year. Here's to hoping.

I do not think that there is any other quality so essential to success of any kind as the quality of perseverance. It overcomes almost everything, even nature.
John D. Rockefeller

I'm inches away

from rock bottom.

Luckily, at work there's no time to feel things. So I'm going to look at the next 13 hour shift as a break from feeling. I hope it's not also going to be a break from eating and drinking again.

What it feels like to stop a person's heart..on purpose..with a syringe

Got a transfer from CSICU yesterday.  Pt was post op day 4, slow to progress (we usually get them by day 2), 4 chest tubes, insulin drip, 4L O2 nasal cannula, edema bilaterally in hands and feet. Had CABGx2, MVR, and MAZE procedure, pacing with external pacing wires 80 rate atrial paced with 10 mAs (why with underlying afib, not sure) and junctional rhythm in 30s-40s. Pt still had not been ambulated (again, usually that starts post op day 2) but my esteemed CSICU RN colleague decided RIGHT BEFORE coming up to my floor (a step down) that would be a good time to get her walking for the first time.
So, needless to say, get my new pt all tucked in, the aide checks her blood pressure and her heart rate is 160.

Yes, that's right... 1 6 0

Plug in the telemetry, and she's in rapid afib!

Mother FUCK.

Turn off external pacer, grab a stat EKG, a fresh set of vitals, BP monitoring every 5 minutes..
pt feels nauseous..  THERE'S NO ZOFRAN ORDERED (of course)

Page cardiologist, he orders 5 mg IV lopressor (decreases rate and BP-- rate is what we wanted controlled and her BP was safely high enough to give it) STAT and orders a stat amiodarone (anti arrhythmic). Also orders zofran for pt's nausea. (just read a study on medscape that says zofran increases risk for torsades de pointes, so I had that in the back of my head worrying me too)

Give the IV lopressor.. Pt resting comfortably.. I stay with her watching the monitor to see if her rate comes down.  Then she says "I don't feel good..." blinks three times, and nods off..

monitor reads ASYSTOLE (yes that's a fucking flatline, folks.. NO HEARTBEAT)
5 seconds pass.. I call for the code cart..
3 more seconds pass..
still flatline..
2 more seconds pass and

her heart started beating

It was a junctional rhythm but it was beating and it was not afib anymore!! I turned the external pacer back on to the original settings and called the cardiologist to tell him she converted.



How does it feel to stop a patient's heart on purpose?

It feels a lot like you'd imagine.. something like HO-LEE SHIT

(Just to clarify here.  There's a procedure called a cardioversion that Drs use to convert people from afib to sinus rhythms.  It can be done ONLY in the presence of a cardioliogist and an assisting RN and various equipment nearby because the conversion is sudden and can cause lengthy pauses of the heart (similar to what was seen here). Hearts can also convert into sinus ( with a small pause) while pts are on  amiodarone drips (hence why it was ordered).  Instances where pts convert from 5 mg of IV lopressor are rare, but it can happen. (Obviously)  ..and it has NEVER happened with ME in the room alone.) So, all of this really wasn't a freak occurrence so much as it was just an intense emergent situation I had never been involved in before.)

I don't condone it, but I understand it

 

http://articles.mcall.com/2011-09-02/news/mc-lower-macungie-wife-beat-mercy-killing-20110902_1_bat-attack-lower-macungie-neighbors-louella

I can’t imagine what it must be like to live with someone who needs that much care and have NO HELP. And do all the house and yard work. And have an outside job.  I get stressed from my three 12s taking care of those requiring complete care and I HAVE help at work.(usually) The difference is, I suppose, I have learned to ask if I need the help. Plus drowning someone just sounds exhausting.

The good news for him, though, is that now he is in prison. With hours upon hours with absolutely nothing to do.

That lucky, lucky bastard. 

“Marx was wrong; jealousy and pride, emotional forces, are just as responsible as hunger and necessity for our actions; they explain the whole of History, and the initial fall  Eugene Ionesco

Sometimes you gotta quit while you're

... a head..??

As an Acute Stroke RN, I really REALLY shouldn't be laughing at this

https://www.facebook.com/photo.php?fbid=10150833042335377&set=a.230724325376.273113.212641675376&type=1&theater

But I'm laughing so hard at the comments to this, I'm almost crying. Hellfire here I come...

Here's your sign

So, I don't often link to other blogs on my blog (not sure why not, maybe I should more often) but this blog jumped out at me.

Some background as to why.. when they added the stroke component to our floor, we started seeing a lot of patients post brain surgery due to intracranial hemorrhages, masses, etc etc. post surgical brain surgery patients were a brand new thing to me and it's always so hard on everyone from the patient to the family to the nursing staff. The family tells you tidbits about what patients were like before the brain injury and it's SO IMPORTANT for healthcare professionals to pay attention to what the family tells you about the patient. It helps you talk to and communicate with the patient's personality (or at least former personality) and give them some sort of identity outside being "that patient with the staples across his/her head". Always treat the person first, the disease second- especially in the case of a brain injury because the soul and spirit  must heal in addition to the body. You can't possibly treat one properly without the other. (I will tell you a story about one of my former brain injury pts. in particular when I have more time).

And now, finally... here's your sign:
http://bravegirlsclub.com/archives/2151

I failed my pregnancy test

So I had a minor procedure at my hospital today (all is well, I'm fine). Prior to the procedure, I had to take a pregnancy test... and I failed:
By dropping the urine specimen cup INTO THE TOILET.  (Only me, I swear to GOD.)

Luckily, I grabbed it out of the toilet before it went totally under, but all my hard work due to having nothing to eat or drink after midnight the night before (it was 12:15 pm by this point) was GONE! My resulting foul mouthed little outburst was heard by a nice elderly gentleman waiting outside the door, too. Not one of my finer moments.
Just so you know, I did manage to finally get a negative result, incidentally, so my oven is bun free.

Then I was telling a friend about how proud I am to work at my hospital because everyone was just so nice and knowledgeable; it was just a great hospital experience, honestly.  This friend then said to me (regarding my experience), "Well, it's kinda like the Colonel getting the best piece of chicken when he stops in..." What a sweet analogy. ♥ I do think that my hospital really *is* just that good, though. I'd never work in a different one. I am definitely home organization-wise.

The highlight of my day, though was when I was coming out of the anesthesia and the nurse said to me, "Are you having any pain?" and I said, "Yeah, it hurts like fuck." LOL
then 1 minute later, she was coming back with the morphine and I said, "Did I say a curse word? Sorry."*blush*  I heard every staff member within earshot cracking the hell up over whatever shit I was blabbing about to anyone who came near me. It was excellent comedic practice for my hospital stays when I am in my 80s.

So anyway, I'm loving this new J. Lo ass. These butt implants RAWK.

Your mother was a hamster and your father smelt of elderberries!

So it's midnight and I am stuffing my face with sour cream and onion potato chips and I'm on my third blueberry lemonade Smirnoff. (which is deee licious, I  might add).
Two weeks ago the menfolk of my house went away to boy scout camp- leaving my daughter and I to do girly stuff.  Lacking all originality, I decided this should mean shopping, manicures, and dinner.

So we are happily jaunting through the mall when we both spied a book store... not just any book store but a used book store.  This was a gold mine to myself and my word devouring spawn! Used books mean they are cheaper; therefore, we can buy more of them than we had ever dreamed! Among the shelves of well loved volumes of classics (by the way, my favorite classic of the summer is Jane Eyre. I read it over vacation and I desperately want to see the 2011 movie version out on DVD now), my little Bambi legged mini me  fleshloaf and I began using.. wait for it...

British accents.

I really don't know why we did it or what even prompted it, but before we knew it, we were having long, drawn out conversations in the thickest, most obnoxious British accents imaginable. We were giggling incessantly and purposely saying words just to see who had the better accent.

Finally we had our books picked out and I found a treasured Erma Bombeck book. (she was one of my favorite writers because she mastered the art of making a person laugh and cry in practically one sentence. So far, I think i just make people cry.) So we pile up our precious stacks of books and there's a kind elderly gentleman behind the counter. He grabs the Erma Bombeck book and says "You like her?" I said "Oh yes!" (I used minimal words due to him hearing a British accent the whole time I was in there). Then he told me all about how he was at Erma's funeral in Arizona, was a personal friend of hers and her family and how he's "not from around here" then about how she was even funnier in person than in her writing, etc etc.. then he asked, "how long have you been here in the States?" I said in a lowered voice "my whole life.."  He said, "What? But your accent ..." I leaned over the counter, held my hand up to the side of my face and loudly whispered, "..we were pretending.." my daughter LOST IT laughing that I confessed our diabolical ruse to the kindly old gentleman.  He paused for quite a few seconds and looked at me from over the top rim of his glasses and simply said, "Oh Erma would have LOVED you."

I can only hope she would have.  I can only hope.



“When I stand before God at the end of my life, I would hope that I would not have a single bit of talent left, and could say, "I used everything you gave me.”

 Erma Bombeck quotes (U.S. humorist, 1927-1996)

Destined for Greatness

I am going to be the BEST confused, restrained old lady patient EVER.  None of my old people have a fucking clue what year it is, where they are or what they are doing in a hospital bed.  They DO; however, remember what they made for dinner the day JFK was assassinated.  That should really be a routine neuro exam question along with asking patients for name, age, and date of birth because EVERYONE who was alive at the time always knows where they were when Kennedy was assassinated.(although, once I got a look of utter shock and the response "OH MY GOD, KENNEDY WAS ASSASSINATED??")  It's really quite fascinating how the brain consistently messes with people's perceptions of reality; and what sticks with people well into old age.

You know what I hate?  Redirecting people who are REALLY confused. I'm always worried I am going to totally freak them out.  For example; imagine if you thought it was 1955 and you are 10 years old and lived with your parents. (that's a whole other ball of wax, those poor little old people who cry for their parents who've been dead for 20+ years, but I digress).  Now imagine if someone told you that it's not 1955, it's 2011 and you just had a stroke and you can't move your right side...
WTF? I can't imagine how confusing and scary that must be for a person. I never had a class specifically addressing confused or pts with dementia, but I think the general consensus is to reorient and tell them reality.  To that I say BULLSHIT. They will forget what you told them in all likelihood in 5 minutes anyway, why traumatize them for 5 minutes? Over and over and over again.  What the hell good does THAT do? (aside from making them require megadoses of antidepressants) I tell them where they are and that they are safe, etc., etc.  but I never go into great detail, unless they ask.

Anyway, I have decided that due to my extensive experience with the aged and confused population, their overall behavior and unpredictable natures have prepared me for the title of being the ULTIMATE old, confused lady.  I figure, by the time I am in my 90s, shit that I see now will be ingrained in my long term memory well enough that I will be able to remember some pretty fuckin awesome tricks.  Perhaps I will conduct classes on the sly in the nursing home.  Classes like how to:

1. Kiss the hand of the nurse and tell her how much you love her then seconds later begin kissing the call bell and telling IT how much you love IT.
2. Throw your clothes off then pretend you have "no idea what happened.  I woke up and my clothes were all over the floor, can you help me get dressed?"
3. Go for an MRI and cause the nurse to get a phone call from the MRI tech informing her that you (the patient) removed an ear plug and began chewing it like a wad of gum.(needless to say, that MRI will be over before it even begins)
4. How to slide out of restraints of any kind then complain about how "The service in this hotel is TERRIBLE. I keep getting all tied up and no one at all comes to help me get loose."
4.part b. Asking every staff member you come into contact with for scissors.
5. Repeatedly asking "when the hell is this ship getting to port? I'm sick of the ocean."
6. Tell the nursing staff about the ghost that keeps on opening up your closet door and hovering over you. (okay, that one might scare me a little... I don't think there is a patient room in a hospital that someone didn't die in, so that could actually be true)

So you see, I am destined for greatness.  I am learning from the masters exactly how to be the most. awesome. patient. ever. Just you wait and see.

My most dangerous and hilarious patient encounter EVER

Back when I was still a nurse's aide in 2009, I was assigned to do a one to one watch on a prisoner. In case you aren't familiar with how it works, hospitals use their nurse's aides to sit in rooms with people who are in danger of hurting themselves or others. If the patients are dangerous, they are put into 4 point locked restraints in addition to the one to one watch.

On this day in particular, I had a prisoner with a prison security guard with him.  Since the security guard was not hospital staff, they still needed me there.  The prison guard had the VERY IMPORTANT job of reading the paper and ignoring the prisoner while I sat arm's length away from the prisoner and getting cursed at and threatened.  The prisoner also had a penchant for spitting, hence the spit shield (an over the face hood made of black netting).  The prisoner was not only inappropriate and verbally abusive, he was also a bit out of it.  Because of this, he kept asking why my panties were over his face. :/

So, dinner arrives and I am informed by the nurse that I have to feed this guy because if we untie his hands he will try to escape.  I am not happy about this because that means I have to raise his spit shield and very likely be spat upon.  AWESOME. Before I decide to raise the shield, I figured I better be sure the guy was actually.. I don't know.. hungry.  So I look him in the eye and say, (very sweetly I might add), "Are you hungry?" He looks directly into my eyes and says in a gruff, muppetlike voice "Yeah, I'm hungry.. HUNGRY FOR YOUR PUSSY!"
:/

The prison guard heard it and I could tell was about to call him a piece of shit or something and I held up my hand to the guard as if to say "just hold on.. don't say anything".  At that point I removed the lid from his tray, slammed the lid down on his bedside table and said, "WELL YOU ARE GETTING SPAGHETTI AND MEATBALLS." Prisoner's demeanor immediately changed to defeat looked down at the tray and opened his mouth for me to feed him and proceeded to obediently eat his meal with no obscenities or spitting. Then he let me brush his teeth after. (his breath was TERRIBLE). The prison guard could not have looked more proud of me. ;)

P.S.  This is what a spit shield looks like. (and for the record, my panties NOWHERE NEAR that size)

Screw this housework noise

I'm SO getting a maid.  Then you know what I'm doing? Hiring a personal trainer.(apparently, if you are a woman you get quite the discount if it's a gym frequented by men) Then my husband will be all "omg, what a great workout housework is!" Then I will hand him a mop and a vacuum and say, "You're looking a little soft. There you go, Mr. Universe!"  Then I can fire the maid.

Truckers and Angels

TJ was a trucker from Michigan, just passing though our little part of PA.  He had just docked his rig and was behind a rather large mound of dirt.  As he made his way around his cab he felt.. something.. sudden shortness of breath, chest pain.. then a sudden definite sense that he was about to die. He gathered what breath he could and let out a cry for help-- knowing full well that from behind that mound of dirt, what little bit of yelling he could do was likely to be muffled. He yelled anyway.

And someone heard him.

He was rushed to my hospital (which happened to be just a block away from where he was). He went to the emergency dept where he lost consciousness within minutes of arrival. He was in congestive heart failure and cardiogenic shock.  He was intubated in the ER and was sent to the medical ICU unit for a week while he stabilized.  His wife was contacted and she tearfully drove straight through non stop from Michigan to be by his side. She sat with him while he was completely knocked out being kept alive by a machine.  Another family in the ICU heard about their plight and paid for her to stay in a local hotel for a week.(Later, the hospital put her up in a special house they use for situations exactly like they were in)  Once TJ was stable they found he had severe aortic stenosis and aortic insufficiency-- he needed a new aortic valve.  So off to surgery he went.

Once TJ was in the OR, in the middle of the surgery, his aorta suddenly dissected.. The surgeons and nurses furiously worked to transfuse blood as TJ slipped further and further away.. after countless units of blood, an emergent Bentall procedure was performed.  TJ lived through the surgery. He lived through the night. And after 4 days in the Cardiac Surgical ICU?  He was all mine.

TJ had two mediastinal and 2 pleural chest tubes protruding from him, indwelling foley catheter, external epicardial pacing wires (capped), in insulin gtt set ay 4 mLs an hour (2 units/hour), a midsternal incision with an acticoat dressing over it, IV venofer running, 4L of O2 via nasal cannula and a humble, scared look on his unshaven/been through war of a face.

I helped him out of his wheelchair and into his recliner.  I frequently checked on him, I ambulated him around in the hallways, I taught both he and his wife about different meds and side effects of them... and he told me his story.

So last night I was saying goodbye to him and I will never forget the things he said to me. He said, "I was never an overly religious man.. but I truly believe it was no accident that I was right around the corner from one of the best cardiac teams on the east coast when my heart gave out. God had one hand on my shoulder and one hand on that surgeon's shoulder when he was operating on me.  The kindness shown to my wife by you people is just as appreciated as the top notch medical treatment you have given to me. I don't really know how to thank any of you enough for all you have done and continue to do.."  and with that, the Grizzly Bear of a trucker wiped huge tears from his kind, blue eyes and I gave him a big hug and I thanked him by telling him, "It's patients like you that make this job the best job in the world, so on behalf of everyone here, thank YOU for allowing us to care for you."

TJ's birthday is coming up on Sunday... his goal is to be home by then.  Something tells me, he's going to make that goal.  I don't think his angels would let him miss it. ;)

PAPER IS MAGICAL

Have a problem with your business?

Add a form!

Patients falling on the floor too often?

Hang a sign on their door!

Too many loose ends in your office's workflow?

Give everyone a checklist!

Let's get down to brass tacks.  Sometimes, circumstances in a workplace change.. sometimes for the better; but more likely than not, for the worse.  Is it REALLY necessary to insult the intelligence of your staff by even hinting that a piece of paper is going to fix an increase in falls?  Dude.. we've got fuckin stroked out (may as well be tripped out) people flinging themselves out of bed all the frigging time.  Do you really think a SIGN is going to help the staff??  How about.. oh I don't know.. STAFFING THE FLOOR PROPERLY?

Hey!! Wanna see my new shirt? It says "ARRRRR" on top and "ENNNNN" on the bottom.

(second half of this message is for the person who told me to lighten up on my blog)  I don't know though, these girls are pretty heavy, not sure how much lightening up they are going to do. *shrug*

A Discussion at the Nurse's Station

A new aide was orienting and she was talking to one of the nurses about getting attached to patients.  The nurse said she doesn't remember much about any patients and that she never got that close to any of them. Then the aide turned to me and said "what about you?"

oy.

I told her I remember most of my patients pretty well and if they died I always look up their obits after so I can learn about them as a person and that I hate knowing people just as "sick".  What I didn't tell her is that I blog about every one of my notable patients, and that I save obit pics on my hard drive so I never forget the faces of my patients who have died.

If the FBI ever looks at my hard drive I hope they also see this blog explaining why I have their pics on it.  Otherwise I'm going to have a lot of splainin' to do.

Like a sheep being lead to slaughter

Not really looking forward to my 3p-3a shift today.

A rare Saturday night post with sad news :(

The four point locked restraint stroke patient died on Wednesday.

That crooked smile of his will forever be etched in my mind.  I'm glad I brought him a little joy before he passed away. He probably had a long road of tube feeds and permanent paralysis ahead of him so in a way God was merciful in letting him go.. and his family was there with him when he passed, so there is that, too...

Rest well, my friend.  I'm sorry we had to restrain you like that, I hope you understand better now why we had to do it.

Top 10 things that contribute to a Work Day from Hell

1. Computer system being down.
2. 2 fresh strokes needing NIH scales and q1 hour neuro checks and frequent vitals the first 8 hours of a 12 hour shift.  One of which was a significant CVA with an NIH of 16 and getting worse with right sided paralysis yet able to SIT UP and launch himself off the side of the bed and give me a left hook to the jaw when trying to help him back into bed. Then calling security to come and put him into 4 point locked restraints and putting him on a 1:1 watch.
3. A 5'4" resident trying to tell me that he doesn't think restraints are appropriate and to try a BABY DOSE of ativan instead. Then watching the patient get his foot stuck in the bottom of the bed then turn and bang his head on the upper side rail. Then telling Security to put the restraints on the patient because he IS A DANGER TO HIMSELF AND OTHERS and if the resident doesn't think those restraints are appropriate that he can come and personally remove them because they are GOING ON NOW.
4. a patient signing himself out AMA because a Dr. told him he could go home but the nurse I got report from didn't have time to do the paperwork with him or discharge him... nor time to take out his IV- so he was found bleeding in the lobby after ripping out his own IV and bleeding everywhere because he's on Coumadin
5. While I wrestling with the CVA pt., my confused lady in Posey restraints pulled out her brand new PICC line which was placed hours before.. also on Coumadin.. it's a miracle she didn't bleed out.
6. Other lady trying to get her last dose of IV iron with an unusable opposite arm (post mastectomy).. both the charge nurse and myself were unable to get an IV site in her after her only usable vein/IV site infiltrated.
7. Confused little Jewish lady crying about how her daughter is going to put her in a home and take all her money therefore trying to escape and setting off her bed alarm.  Every. 15. minutes.
8. Clocking in at 230pm and clocking out at 430am without taking a break or eating anything the entire time.
9. Whiny nurse's aides about how BUSY they are.
10. Having a killer headache and cramps the entire time.

 And in keeping with the irony that is my life, my favorite thing about the day was talking to and massaging legs, chest and back of the violent stroke patient in restraints and getting a giant half smile from him.(couldn't even smile with the right side of his face.)  That picture of him is frozen in my mind and actually brings me to tears when I think of it.

Suicide Notes and Peyronie's Disease

Had a 60 something female patient come in post suicide attempt.  They recently closed the local large psych facility so once our psych floor gets full, we get suicidal patients and the occasional patient with psychosis  who attacks the staff with scissors.. but that's another story.  So, this 60 something patient attempted suicide by taking a bunch of ativan and vicodin and I think Seroquel.  So she says.. her vitals were stable but the ER report was unclear as to whether or not the induced vomiting or pumped her stomach.  I think she waited few hours to call for help so I doubt it would have worked if they had.   So as I am flipping through her chart and I saw her suicide note.  The first few lines were:

Dear Susan (daughter's name- changed for her protection):
YOU DID THIS....(commence a bunch of incoherent, half legible babbling for about 6 pages)

I spoke to Susan several times.  Her mother has a long psych history.  Susan was 8 months pregnant and had 3 other little children under 5 at home.  (she came in later that day) Her husband was very kind and patient with the whole thing, too.

I'm going to admit something.  That note not only rattled me- it pissed me off. How could someone 1. base so much of their happiness on a GROWN CHILD WITH HER OWN LIFE and  2. Try to kill herself then leave a note so the daughter (who probably would have blamed herself somehow anyway) can see it and know beyond doubt that IT'S ALL HER FAULT YOU ARE DEAD  ...while she's about to GIVE BIRTH.

What kind of self centered, immature, narcissistic piece of SHIT does that to their own child??  Who the fuck goes through 60 years of life thinking it's ALL ABOUT THEM?  The whole situation totally disgusted me.  I was actually going to ask for a different assignment (a good nurse knows when a situation is one where his/her own feelings might affect care).. but the other nurse who would have taken her was about half as compassionate as me on her best day, so I sucked it up and used my therapeutic communication skills-- which luckily means asking open ended questions and never giving your personal opinion or advice.. so thank God for THAT.


We also had this really odd, hard to read patient who was very non compliant with his insulin at home and rarely took his cardiac meds.  He told our poor elderly nurse's aid (the one I mentioned on the talented  boobie post) while she was taking his blood pressure that he neglected to mention when he was admitted that he has a condition called Peyronie's disease and we are "ALL going to get it now!"  So the nurses were at the nurse's station FREAKING OUT about this horrible disease and what is it OMG!!!  Well I knew every disease that you can catch from casual contact and that was not one of them I ever heard of, so I looked it up.

According to wikipedia: (http://en.wikipedia.org/wiki/Peyronie%27s_disease)

Peyronie's Disease (also known as "Induratio penis plastica"^[1]) and more recently (CITA) Chronic Inflammation of Tunica Albuginea, is a connective tissue disorder involving the growth of fibrous plaques^[2] in the soft tissue of the penis affecting up to 10% of men. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening.

So basically the guy told the nurse's aid he has a  dick with a right angle and we were ALL GOING TO CATCH IT.  So, I did what any good nurse would do.  I put a contact precaution bag on his door and pretended like he had a raging case of MRSA,  I told everyone to gown up and glove up every time they go into the room.  The guy was BUSTING A GUT laughing at how we fell for his scheme.  And just when I was about to break the news that we knew his condition was not contagious.. the Dr showed up.

Dr.:"Why is this patient on contact precautions?"
I looked at the patient and said "Do you want to tell him or should I?"
Patient (proudly): "I have Peyronie's disease!"
Dr.(flatly): "um.. that's not contagious"
Me: "Oh Dr., I don't know what we would do without YOU around!" *grabbing isolation bag from the door and scurrying out*

Ten minutes later, the Dr. came up to me and said "You knew what it was, didn't you?"

I just winked.

LOL

Oh Boy! I get to work during the ZOMBIE APOCALYPSE this Saturday!

This is what I am imagining it will be like.

(Hey, a gal can dream..)


Addendum after the fateful weekend:

Dancing Skeletons

One of my all time favorite books is not a classical piece of literature, nor was it ever even a best seller.

http://www.amazon.com/Dancing-Skeletons-Life-Death-Africa/dp/088133748X

I came upon the book when I was reading about breastfeeding when I was pregnant with my first.  Once I got through the anatomy of breastfeeding, I became interested in the history of it and the cultural aspect of it.  I began to wonder about breastfeeding and nutrition in other cultures and how it differs from our own.  I started devouring books on anthropology and found the subject fascinating. (Sadly, I never had the opportunity to take a class in anthropology while getting my B.S. in Education nor for my nursing degree).

One of my favorite stories in the book was when the author had stool samples in glass jars (to test for parasites) and she was riding in the back of a pickup truck with local villagers.  Unbeknownst to them, she spoke their language fluently (I forget the name of the language.. but it had a french influence).  They called white people "Toubabs" and while they were riding along the countryside with her they were saying "Wow, this Toubab smells like SHIT!". LOL!  There was a lot of fascinating things about West African culture in the book such as during a survey, the author asked villagers what food they would buy when she gave them all a little bit of money for helping her with her research.  They looked at her like she was crazy and they were insulted-- they all said "we have plenty of rice and bread, we aren't hungry.."  To them, food wasn't consumed for pleasure, it was basically to keep them from being hungry.  What an alien concept to Americans!

Anyway, my point in telling you all this is I had a patient who works for the U.N. and works at an African embassy (I can't remember which one).  She had strokelike symptoms and rushed back to the US for treatment.  (She actually resides in the city my hospital is located).  We got to talking and when she mentioned where she grew up and that there was a strong French influence there I said "Oh, you are from West Africa!" she said "yes!" Then I said, "Oh! Then you can call me Toubab!"
You should have seen the shocked/impressed look on her face! lol  We got to talk about so many things in the book and she was genuinely excited to talk about growing up in West Africa and how times have changed and how amazingly different it is living in the US and how fortunate she is to have the privileges she now does. And OF COURSE I had to tell her about the Toubab shit story which made her laugh and laugh. lol  This story is just another example of why it is SO IMPORTANT to be a well rounded person and to never stop learning, you never know the impact your curiosity could have on another person later in life and it helps you gain such a unique perspective on things.

Never a dull moment..

My Unit Manager  "resigned" quite suddenly yesterday.  The entire floor is in absolute turmoil right now.  We have no idea who will be taking her place or when.  Good news is, even though we all just had CVAs/TIAs(stroke) patients added to our population, we just hit 99th percentile again on patient satisfaction scores.  I have to say that's a HUGE accomplishment considering the other unit who had all stroke patients routinely scored quite poorly on patient satisfaction surveys.  (and their thought was that  because a lot of the patients either died or went to rehab and were unable to fill out the forms the only people who filled them out were disgruntled pts who had a score to settle of some kind.) I am part of an awesome team of nurses and I am so proud of all we have accomplished so far. I am kind of grateful now for my stroke patients because I think I needed a new challenge and a new set of skills to pick up.  All of this crap I am dealing with is making me so much better of a nurse and I think it's making all our nurses stronger as a team as well.  So time will tell how things work out with a new manager, etc. but I have to confess- I really love my job. *whispering* don't tell anyone.

Nurse's Week is almost here!

And my friends aren't missing a beat....

 Oh dear, sweet GOD.. LOL!

A little off topic..

I feel compelled to comment on the death of Osama Bin Laden.  Perhaps it's just my perspective on things, but the mass celebration of ANYONE 'S death troubles me very deeply.  I recall seeing people in foreign countries rallying in the streets and being joyous when one negative thing happened to the USA or another and thinking how it makes them look like animals.  The US looks no better to me right now.  Seeing facebook updates of moms of preschoolers who ordinarily drone on about scrapbooking celebrating a bullet in a man's head is just frightening to me.

 Yes 9/11 was horrible, yes people died yes, that day shook our nation to its very core, yes Osama was a danger to all our safety for as long as he walked this earth; so yes, he needed to die- but it was a necessary evil.

Partying over anyone's death is absolutely disgusting to me and I fear the type of reaction our nation had to the news of Osama's death is going to come back to haunt us and our troops overseas.

Have a little grace, America, and wise the fuck up before more people are hurt.

"I mourn the loss of thousands of precious lives, but I will not rejoice in the death of one, not even an enemy. Returning hate for hate multiplies hate, adding deeper darkness to a night already devoid of stars. Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that." —MLK Jr

Aneurysm Guy Update

He got to Cleveland, OH on Tuesday and upon reviewing his information, they said it is inoperable.  They were medically managing his pain and blood pressures.  He went into the bathroom to have a bowel movement on Thursday and it ruptured. He died within minutes.


I thought about what his final minutes were like.  The searing pain, the warmth of blood rising up from his throat, the terror of what that must have felt like, knowing exactly what was happening to him.. then I realized what came right after that initial shock of what was happening.  A peaceful surrender.. a calm sense of finality. The knowledge that very soon, all the pain will cease to exist.  Flashes of his family's smiles.  His mother tucking him in at night.  His wedding day.  The day he was told he was a ticking time bomb.  The worry was finally leaving him, the uncertainty gone. He finally knew exactly how long he had left and it was okay. It had to be; what other choice did he have?(his exact words re: his trip to OH when his family asked him what he wanted to do about having the surgery)  So he relaxed, slumped over, and let his blood pressure fall.
and I remember clearly his words to me when I was discussing the gravity of his diagnosis with him to which he said,  "We all gotta go sometime, kid.."

I really am lucky to have the job that I have.  I sometimes feel as though I am on border patrol to the pearly gates, and I feel pretty sure I will have A LOT of friends on the inside when my time is up.  Hopefully they will save me the good seats at Bingo.

Timing is Everything

I found a man face down on the hospital floor at 8:02 am on Saturday morning on my float to another hospital floor.  I saw a foot with a black sock sticking out from underneath the curtain.  I pulled back the drape and the man was face down on the floor , his IV pump whirring with normal saline fluids.  I instinctively put my hand on his naked back.. he still felt warm.  I asked him if he was ok and I got no response.  I felt for a pulse, there was none. I flicked on the light and looked at his face.  It was completely cyanotic (blue). I yelled for someone to please come in and I pulled out my handheld phone and told the operator we had a code blue (if you ever wondered why it's called a code blue... now you know).  I tried to roll him over to start chest compressions but he was too big and I couldn't do it myself. Finally another nurse arrived and a nurse's aid.  I still heard no announcement about a code blue. I called again and said "Did you hear me?  We have a Code Blue!! on floor x!!"  The operator responded with, "I'm not sure how to announce that.. I'm getting someone right now who knows.."

Um, okay.. don't you think the FIRST THING they teach in operator person school IN A HOSPITAL is how to call a CODE FUCKIN BLUE? Are you KIDDING ME?  45 seconds later I heard the announcement over the PA system and the code team arrived 2 minutes later. We got him rolled over, started chest compressions, and when we had enough people we got him up into his bed and started pushing meds while doing CPR trying to get him back.  It didn't work, he was gone too long. :(  I also was there when the Dr. called the family.  She was a young resident and her exact words were, "I'm sorry, we did everything we could, but your husband didn't make it.." then the family started yelling asking why no one called earlier (the resident called after 30 minutes of working on him).  I can tell you from past experience, typically a designated doc will break off from the code 5 to 10 minutes into the code to tell the family what is happening.  How the family knew this was commonplace is beyond me.  Anyway.. I wish the resident had reasoned out how to make this call a little better in her mind.  This gentleman's primary diagnosis was a KIDNEY INFECTION. Can you just imagine your loved one being in the hospital for an infection and you getting a calling 8:30 am that "we're sorry we did everything we could, he didn't make it"??  I am sure the resident thought she was doing everything correctly (the books say that's how you handle it) BUT, a better approach would have been to actually call a few  minutes into the code and say "Mrs. x, This is Dr. xyz from blah blah hospital. Your husband's health has taken an unexpected turn. We are currently performing CPR and hoping to revive him, please drive safely in getting here..."  This approach is better for 2 reasons.. if you call right away during the code, the patient isn't technically dead yet (or at least hasn't been pronounced dead), plus, you don't have to tell someone over the phone that their loved one has passed.  What's really distressing about this is the fact that we probably could have saved him if he were on telemetry (cardiac monitoring).  Lord only knows how long he was laying there on the floor... we would have known right away if his heart had stopped had he been ordered to wear it.  And even though his admitting diagnosis was pyelonephritis, a quick glance at his cardiac history would have shown cardiomyopathy and a heightened risk of endocarditis. (which I don't know if they were even checking for by that point).  But, I guess the bottom line is, it was is time to go because that's what his circumstances led him to.. I suspect the whole experience of that code provided valuable lessons to each of us involved and somewhere down the line a life will be saved thanks to that experience... or at the very least the blow of losing a father/mother/husband/wife/son will be softened for someone else down the line.

Enter my patient with a 11.1 (4.9 inch) thoracic aortic aneurysm.   In 2010 it was 7 cm.. it has been growing and that is NOT a good sign.  Aneurysms are notoriously deadly and having seen what it looks like when one ruptures; suffice it to say it's a horrific way to die.  Our surgeons will not TOUCH his aneurysm.  Way too unstable, way too large.  The words "ticking time bomb" are synonymous with this patient whenever we are referring to him.  When I got report on him, the hope was that he would be able to be transported to a hospital in Cleveland OH that specializes in aortic aneurysm repairs.  To look at the Dr's credentials it's pretty impressive- I definitely think they will be able to help him.  If only we can get him there in time.  On the positive side, his blood pressures have been on the low side (a high BP will surely rupture it) on the negative side I had to keep him dosed with oxycodone to help him deal with his back pain.. a sure sign that he's going to rupture at any time..  I spent HOURS on the phone with the transferring hospital's transfer dept, ICU nurses, tried to arrange air transport, medicare won't pay, family has to approve, patient doesn't want to put up cash, ALS vs. BLS transport, our nurse supervisor trying to call our case mgmnt team, no one answering, me calling back and forth to the family.  All the while getting two new stroke admissions with q1 hour neuro checks and a complete NIH scale admission and confused post hip fracture patient. Oh, did I mention I have a horrible cough, fever and a sore throat and barely a voice and that on Sunday I was absolutely unable to get out of bed? Probably because, like a dumbass on Saturday, I didn't eat or drink anything for my entire shift when I already was sick and frankly the thought of eating or drinking just didn't appeal to me.
Anyway.. it's all behind me now.. I called work, aneurysm guy is on his way to Cleveland, it's a beautiful, sunny day and I have two gorgeous children who are about to run off the school bus and into my arms.
Timing really is everything. :)

Just a few things..

Had an overall decent weekend at work. Got to go home early (1130pm) today, it was nice. I got back my patients from Saturday and Sunday and the two biggest pains in my ASS were transferred to other floors (hell YEAH baby!) And I got left with a cute 98 year old lady, an adorable 95 year old lady, a new stroke on a 84 year old lady and a PITA 55 year old lady who takes more meds than the other 3 women I mentioned COMBINED.

PITA #1 was a dude with Hep C and a bleeding disorder and he constantly had fresh, bright red blood in his mouth coming out of his gums. Plus his liver was shot so his ammonia levels were sky high and affecting his cognition and sense of balance. His gown was covered in blood, his room was a sty, he was forever pissing all over the floor and if I sound a little harsh talking about him it might be because the motherfucker HIT me in the arm when I gave him a shot of insulin in addition to calling ME a pain in the ass and looking at me with absolute venom every time I entered the room. Then he proceeded to call me a bitch every chance he had. At one point I walked into his room to give him some scheduled meds and he started saying "OH GOD, what do you want NOW!?  Jesus!" then I said, "Look, I don't want to be in here any more than you want me in here, so just let me do my job and I promise I will be getting away from you as quickly as I possibly can."  And then I hummed this song every time I was in his room:

A good patient I had was a 98 year old lady whose grandson was visiting and noticed her speech was getting slurred and she wasn't walking straight.  He called 911 and the ambulance came right away.  Upon arrival to my hospital, she was administered the clot busting medication TPA.  Within a few hours, all her stroke symptoms resolved. She was coherent, bright eyed and quite spunky when I got her.  I met her Grandson and thanked him for acting so quickly- he saved his Grandmother from an end in life that I see all too often.  She was really cute, too.  She said the state sent her a driver's license when she was 96 but she decided not to drive anymore.. not because she thought she couldn't, but because she said, "God forbid if someone ever hit me, the first thing everyone would say would be 'what was a 96 year old doing driving?!' and then I'd end up getting blamed for it.  So it was my choice to stop driving."  This little lady had more brains and sense than most 40 somethings I care for. Anyway, what I learned from her was firsthand how important it is to be able to catch a stroke in its early stages-- it's truly a medical MIRACLE what tpa can do.  I think we've all heard how critical timing is with catching and treating strokes.. but until you see it firsthand?? Just wow. Amazing.

Okay, God. I get it. :)

Look what just came in the mail today.

When the world says, "Give up,"
Hope whispers, "Try it one more time."
~Author Unknown


There are no mistakes, no coincidences. All events are blessings given to us to learn from. ~ Elisabeth Kubler-Ross

I LOVE MY JOB I LOVE MY JOB I LOVE MY JOB I LOVE MY JOB

Where I've been

I've finally been broken.

I've had a lot of professional successes and a lot of personal turmoil the past few months.  Had a patient whose wife had recently died of cancer and he needed to have open heart surgery.  Admitted himself several times and each time signed out AMA, deciding he would rather just die than try to add unwanted years to his life.  Enter Dr. T.  He's an incredibly compassionate cardiac surgeon who's been with the network for many years.  He took a personal interest in this man's story and was quite determined to do everything in his power to persuade this man to have the surgery.(Dr. T has an incredible bedside manner, brings treats for the staff whenever he comes in.. he's the embodiment of everything a Dr. should be.) One admission on a Saturday, I once again admitted the patient and I took it upon myself to call Dr. T at home to see if he can talk to him about having the surgery one more time.  Dr. T came to the hospital in his sweatpants to talk to this patient.  Long story short... the patient finally had the surgery, and I even got to be his discharging RN. It was so wonderful to be able to hug him and send him on his way with his brand new lease on life.  I hope he will go on to find the good in life and find reasons to continue to take care of himself.

Not a week after all this took place, an email arrived in my email box saying Dr. T will no longer be with the network. My immediate thought was "aw I'm so sad he's retiring :("
Only he WASN'T retiring.  Turns out the hospital is pushing him out for political reasons (paying him too much? Maybe other surgeons feeling he was stealing their thunder..? I don't know).   I am hurt, angry and saddened by the news of his leaving and I feel the hospital is losing a HUGE piece of its culture and soul by cutting him loose.  I actually nominated him for a special hospital award as a final way to stick it to the hospital for being complete ASSHOLES.

On the heels of that nonsense, they decided to close the Neuroscience/Stroke Unit and combine the stroke population with our cardiothoracic post op surgical floor and up our nurse to patient ratios.  So now, instead of 5 patients, I have a 6 patient assignment- and MORE WORK, more patients that are "completes" (meaning immobile, diapered, and unable to feed themselves most of the time), and we get new stroke admissions which means hourly neurochecks and vital signs for the first 8 hours of their admission then every 4 hour neuro checks in addition to dysphagia assessments prior to pts being allowed to eat and stat MRIs not to mention caring for pts with chest tubes, PEG tubes, Amiodarone/Dobutamine/Heparin/Nitroglycerin/Cardizem/Insulin drips post cardiac caths, CABGs, ablations, and cardioversions.  And for SOME mysterious reason every single patient assignment I have had has had at least 2 terminal cancer patients.


I'm not sleeping well, I feel fatigued on my days off and I am just generally not myself, so.. yeah.. That's why I've been quiet.  On the upside, none of my patients has any clue I'm under all this pressure and I hear many times a day what a wonderful nurse I am, so that is nice, at least.  I just wish my kids didn't have to catch me crying every once in a while.