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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