Addendum after the fateful weekend:
Thursday, May 19, 2011
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:
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.
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.
Wednesday, May 18, 2011
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.
Thursday, May 5, 2011
Monday, May 2, 2011
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.
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.
Saturday, April 30, 2011
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.
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.
Tuesday, April 26, 2011
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. :)
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. :)
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