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.)