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Monday, October 28, 2013

It's Been Way Too Long. . .

It has been way too damned long since I've posted anything. . . about five months or so.  I think that part of the problem is that, when I get home from work, the last thing I want to do is think about work.  I just want to get it off of my mind and move on with my day.

For some reason, I got off work this morning, came home, and opened up the old blog.  Well, I got all nostalgic and decided to write something again.  To be honest, I don't know if I will keep it up or not.  But, I'm in the mood. . . time now.

Friday, May 31, 2013

Ok, I've Said It Before, And I'll Say It Again. . .

I've talked about people asking me about becoming a doctor before. . . sort of.  I actually linked to somebody else talking about it.  They said it as well as I could.

Last night, I had a patient who was fairly advanced in age.  Her daughters were with her.  When I came into the room I introduced myself as the triage nurse and explained what I would be doing.  As I finished my assessment, the patient asked me, "you're the doctor, right?"  I responded by telling her I was the triage nurse and what my job was.  The rest of the conversation went like this:
Annoying Lady: But you're going to be a doctor. . .
NurseHubba: No, ma'am.  I'm a nurse.  I don't want to be a doctor. 
Annoying Lady: Oh, I bet you don't.  That makes sense.
NurseHubba: *smiles*
Annoying Lady: They work way too hard.  I wouldn't want to do that either.
Suddenly, I found myself wanting to throat punch an old lady.  What the hell does she think nurses do?   Sit on our ass and do the NY Times crossword all shift?

Don't get me wrong, I appreciate the doctors and all that they do.  There is a lot of responsibility there.  But, who is it that is actually carrying out most of the treatments, assessment, and patient care?  The nurses!

Again, love the docs. . . but come on!

Thursday, May 30, 2013

Great Advice For New Grads ***UPDATED***

I'm posting links to three articles that I read today from Shepherd Of The Gurneys, written by Aesop.  These are specifically for those of you who are students now, are about to graduate, or have just graduated.

Aesop gives some good advice in these, and I really recommend you take the time to read them.  And, even if you're an experienced nurse, they're fun to read and reminisce about your own "new nurse" experience.  Ok, here they are:
Part I: Commencement
Part II: NCLEX, and getting a job
Part III: Doing It 
Enjoy, and take the advice to heart!

This Sets The Tone For The Night

Ok, many of you know that I work night shift.  So, I come on around 7pm and work until 7am.

This particular night, I was working triage.  In our ER, we have a "pull 'til full" system where patients are brought to a room immediately until we are full up.  Then, we begin the normal triage system where people end up sitting in the waiting room.  If we aren't full, then the EMS patients coming in are triaged by the triage nurse when they come in.  If full, the primary nurse or the charge nurse nurse gets in there to do it.

This night, I came in to a very nice looking board with only a handful of patients on it.  This, in itself, is a miracle at 7 in the evening.  Right when I came on, the outgoing triage nurse told me that everything was caught up and that we just had one ambulance out.

Sweet.  This is an excellent situation to come in to.  I've had some seriously shitty shift changes leading up to this, so I'm excited to have a good one.

EMS arrives with the patient on a stretcher.  She's kind of just looking around, wide-eyed.  She's surrounded by six EMTs of various levels, including the shift leader.  Hmmmmm, that doesn't seem like a great sign.  I start to walk towards them and the shift leader says, "Hey, NurseHubba.  Whatcha got tonight?"  I reply that I'm triaging, and he kind of giggles.  Then he says, "Come here, bro.  I gotta talk to you about this one."  He pulls me off to a corner of the ER and gives me the run down:
"Dude, this chick is seriously jacked up.  42 year old female.  Found her in a hotel parking lot with no clothes on.  She's got no ID.  No nothing.  We don't know where she came from.  Asked around at the hotel lobby, restaurant next door, and the gas station across the street.  Nobody has any idea.  But, bro. . . she's batshit crazy.  She agreed to come in, but I don't know what the vital signs are because she wouldn't let me take them.  Won't let me assess or anything.  You're probably gonna need a sitter and maybe even some restraints.  Sometimes, she decides to 'go off' and you have to get her back down.  Sorry, man.  Good luck."
After hearing this report, I was sure glad that I was triaging and not having to take care of this patient all night.  Immediately, she tried to get up and get the hell out.  Remember, she's nude.  The sheet she was covered with dropped to the floor and she tried to bolt in all her glory.  I got an order for physical restraints from the doc, but not chemical (drugs).   Ok, this made it a little easier, but it was hard to get a good physical assessment done.  Ok, fine.  Vital signs, which I was able to get, were pretty normal, though.  The lady was a useless historian, unable to tell me anything.  I couldn't find any obvious injury or trauma.

Ok, so she's restrained.  She's screaming (sort of) in this weird, raspy, exorcist sounding voice, that she wants water.  Nurse Shaggy (who started at the hospital at the same time as me and has LOTS of hair) is a really nice dude.  He decides to let her out for a few, give her some water, then re-restrain her.

Of course, she tries to bolt.  We all get her back in bed and restrained again.  Two hours later, an hour and a half after an initial dose of Geodon and Ativan, we are completely full with too many ambulances out and too many people in the waiting room.  So, I'm in "the box."  This is what we call the triage area.

Suddenly, I hear multiple voices screaming, "SECURITY!!!  GET SECURITY!!!  SHE'S LOOSE!!!"  I look out the little window that faces into the waiting room and see a very large, very naked woman sprinting through the waiting room with three nurses and our security dude chasing her out the front door to the ER and into the night.

The patient that I am triaging at the moment is there just to have a ring cut off, which I was in the middle of when the commotion happened.  She looked up at me with the most horrified, scared look I have ever seen.

I looked at her, shrugged, and said, "Meh.  Just another night in the ER."

Monday, May 27, 2013

Really, Nursing Home?

*Received a call from a nurse at a nursing home around 5:30am.
Shouldn't Be A Nurse: Hi, just wanted to call and give you guys a report on a patient we are sending you.
NurseHubba: Oh, ok.  Go for it.
Shouldn't Be A Nurse: Ok, 92 year old male with moderate dementia.  No complaints, but we did his vital sign check at 4 and found his O2 Sats were down to 72.  We put him on oxygen at 1L, and got sats to 78.  Went up to 2L and got sats to 84.  Went up to 3L and got sats to 90.  EMS is about to leave with him, so they'll be there in a few minutes.
NurseHubba: So his sats are doing better now, then. . .
Shouldn't Be A Nurse: Well, no. . . after a few minutes, his sats went back down to 78 on the 3L.
NurseHubba: Alright, so you weren't really ever able to get his sats up.  Does he have any respiratory or cardiac issues?  Is he sick right now?  
Shouldn't Be A Nurse:  Nooooooo. . . but. . . He's a DNR *click*

A Refreshing Moment

Had a gentleman come to us from home recently who was, basically, a vegetable.

There was no quality of life.  He could communicate a little and was breathing on his own, but couldn't feed himself (had a PEG tube), bathe himself, get out of bed, or even move (really bad contractures).  The family had a nurse that was at the house most of the time to take care of him.  The rest of the time, the family did it.

The family wasn't home when the man started having severe chest pain, so the nurse called EMS.  He got to us and turned out out to be having a STEMI.  The family had been called (including the daughter with medical power of attorney) and arrived at the same time as the ambulance.

As we started our STEMI procedures, the man sort of whispered to one of the nurses, "Please. . . no."  The nurse had me come over and we asked him to repeat what he said.  Again, "Please. . . no. . . stop." The daughter with POA was brought in and witnessed her father say, again, "No. . . please. . . just stop."

Tears began to roll down her face and she said, shakily, "Ok, Daddy.  We'll let you rest now.  I love you."

She left the room momentarily, giving us a chance to clean up the room and set up chairs bedside for the rest of the family.  She returned shortly with the other family members.  The dying gentleman continued to receive comfort measures for pain, nausea, etc.

It took some time, but the family was able to be there with their loved one, holding his hand, giving him their love.  How refreshing to see a family that didn't want to continue torture on a poor old man who had lived his life, had no quality of life now, and was ready to go.  How refreshing to see a family honor the wishes of a dying man rather than prolong his suffering in order to selfishly delay their own grief.

In my not-so-humble opinion, this family did it right.

Monday, May 20, 2013

This Should NEVER EVER Happen!!!

Ok, so this isn't my experience, but that of a co-worker.

I just want to say that nobody should EVER EVER EVER EVER EVER have to pick maggots out of parts of another living human being.

It's just wrong.  Maggots should not live off of living humans.  Want to know where these maggots were found?  Within the fat folds of a nearly SEVEN HUNDRED POUND person.  Ok, if you're a little overweight, I get it.  I, myself, am a little overweight.  And, when I notice myself weighing more than I want to weigh, start exercising more control over myself in order to stay within my personal weight requirements.

If you weigh NEARLY SEVEN HUNDRED POUNDS, it's time to rethink your lifestyle.  Ok, you came in for abdominal pain.  Unfortunately, we just can't diagnose it with the blood work, clinical exam, etc.  We're going to need a scan.

Guess what?  Normal CT machines can't fit somebody that big.  So, you know what we need to do?  Nope.  Not transfer to another hospital with a larger CT machine.  The answer is that we need to transfer you to a popular ANIMAL PARK in order to find a scanner large enough for you.  We need a scanner that can accomodate a person the size of a small whale.


Ok, I realize I may sound a little insensitive, but COME ON!!!