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