A day, evening and/or night in the life of an ER nurse

You may say I'm "just a nurse," but...

2011-04-27T22:53:00.000-07:00

this nurse saved a few people's lives! Pushed and pushed for a re-eval for a pt that they were trying and pushing me to send home. Turned out she had a ruptured spleen, was bleeding into her belly, and needed to have emergent surgery and ended up in ICU. Also, got into a debate w/ a physician about the dose of a cardiac drip. For all my nursing friends who read this, you definitely do NOT hang a Cardizem drip @ 30mg/hour. I refused and told him he either needed to come up w /a different plan or consult w/ cardiology b/c what we were doing was not working! He wasn't pleased w/ me when I said, "When was the last time you actually hung a Cardizem drip?" Lol...So glad I have some experience and critical thinking and am not a robot following doctor's orders!

Long awaited update!

2011-04-21T18:48:00.000-07:00

Recently, there have of sad patients...35 y/o woman found down in cardiac arrest outside of a shopping mall and pronounced dead at the hospital w/o any known cause. drunk girl vs. tree, man vs. Metro (suicide attempt), man vs. 4th floor jump (suicide attempt)... and a lot of other stupidity. Young girl w/ depression and some kind of coagulation disorder that overdosed on Coumadin and Benadryl. I apparently walked in on a very old school but effective gastric lavage to see if they needed any help and literally, her vomit flew across the room at hit me in the face. Nice.

Of course there is the usual weirdness. A 24 year old rational (or so I thought) thinking girl asked me if the apple juice I brought her, in the clearly marked and sealed apple juice cup, was in fact somebody else's urine and was convinced that it was despite my attempts to assuage her fears. She refused to drink it and kept going on and on about how it "smelled like urine." Um... I didn't even know what to say.

Then today I had a very sweet 90 y/o WW2 vet who was on some trip from Kansas to see the WW2 memorial who fell off the top bunk this morning and came in w/ a fractured rib. He was being discharged and was being wheeled out to his car when he literally slumped over in the chair. Yes, he went into cardiac arrest. He was coded two times and brought back successfully! He completely came to, was speaking appropriately and we got to do a lot of chatting throughout the day. Eventually he was telling me how he was on Facebook. I seriously considered friend-ing him! So cute!

Oh na na, what's my name?

2011-03-17T21:28:00.000-07:00

So today I had the pleasure of meeting up with a patient that I knew quite well from my previous job... except for today she registered under a new name. Of course I had the luck of the draw to get assigned to her, so I promptly went into the room and addressed her by her real name. She was not pleased.... she also did not like when I was trying (in vain.. no pun intended!) to draw some blood from her. Since it looked like she was spray tanned w/ track marks, I mean ALL up and down her neck, arms legs, she chastised me for sticking her in her arm, saying "You know I'm an exotic dancer, and if my arm is messed up, I can't put in my teeth!"

After about 2 hours she admitted that she knew me. When I was discharging her (kicking her out... with a box lunch and the obligatory bus token) I was going over her instructions about her diabetes because her blood sugar was high, and she told me "You know that number is good for me!"

Sigh...

Can somebody tell the old lady

2010-12-31T18:29:00.001-08:00

that just because she doesn't like the nursing home, she can't call 911 and come back to the ER? We are going to send you right back!

The beginning of a beautiful friendship...

2010-10-06T15:08:00.001-07:00

Well folks, I did it. I jumped ship, bailed on my old job and took a new one at the trauma center. Very excited! Closer to home, much better pay and trauma! Let's just hope it's not "mo money mo problems," right Biggie?

Long week of general orientation = painful!!! Driving 1.5 hours each way w/ traffic to sit 8 hours in a classroom where only 1 or 2 presentations are applicable to ED/trauma. Seriously, if I ever find myself putting up a tube feeding I will seriously reconsider my workplace!!!

Glad to be in a new, more positive work environment. Hope things will be better!!! For now, I'm about to make myself horizontal on the couch in front of the TV. Catch you later!

2010-08-28T13:29:00.000-07:00

People are going to get hurt. People are going to die, good people, no matter what we do, in spite of what we do. That’s just something you’re going to have to get used to. That’s the reality. That’s the job.

Heard this today on a tv show and it brought back some memories... sometimes you never forget the good ones you lost.

Parasites and love songs and all kinds of crazy

2010-08-18T20:45:00.000-07:00

The story of my day! Picked up a day shift..... 7a-3p today. Slept 3 1/2 hours before going to work in the pouring rain. Definitely off to a good start. Then, got to work, and had 5 patient assignments. No biggie. Got the day started out by helping with a STEMI - my favorite kind of patient. (For my non-nursing friends, that is a: non-ST elevation MI = heart attack). Poor guy had to admit that he started having chest pain after having some early morning sex...

Had a series of truly bizarre patients. A seizure patient that had a significant head trauma some time ago sang me a love song with his slow slurred speech. Another patient wanted to be evaluated for her chest pain (as she is clutching her armpit), oh and also, the redness on her ear, the bug bite on her neck, the rash on her legs. And, my nemesis for today - a lady who wanted to get treatment for the intestinal parasite that her ex-best friend gave her AFTER this said friend had an affair with her husband. this was "not in her imagination" and she was "fearing for her life." She also had a major crush on the doctor who was taking care of her. She asked me to keep her stool sample hidden from him, she didn't want him to see it....... *sigh*

Then there was a drug-seeker who of course came in my ambulance, laid in the bed, threw her arms up in the air and said "I'm having a stroke." Ok. Sure. Whatever you say.

Then there was my man in the hallway who kept grabbing his testicles because "they were about to explode." ????????????? Nevermind that he was just evaluated for the same exact thing yesterday but said he wasn't able to "tolerate the Percocet." This was fun as he admitted to being an IV drug abuser... very very hard to get a good line on him.

3:30 couldn't come fast enough, and by the time I gave report on my 6 patients I was outta there! Tell me why I signed up for 3-11 tomorrow.... I think my wallet is making decisions without me.

Off to bed to recuperate the lost sleep from last night!

Di-la-la

2010-08-10T06:59:00.000-07:00

Dilaudid, for some people, I'm sure is a wonderful drug, fabulous for pain relief. For me, it is my arch nemesis. It turns my patients into crazy, sleep-walking nutcases who rate their pain 10/10 despite the fact that they were dead-to-the-world asleep when I walked in the room.

Case in point: 2 patients I had last week

1) 40-something year old man, nasty as can be, a rude arrogant jerk. He refused to allow me to take an oral temperature until I gave him some more pain meds ("something that started with a D, I think... I can't remember"). Um, do you think I'm an idiot?

2) 30-something year old woman, who appeared to be sleeping standing up when I checked on her. She had received a whopping 6mg (keep in mind that 1mg Dilaudid is like 10mg Morphine). She was slurring her words, leaning over the stretcher, literally dozing as she was trying to put on her lipstick. It inevitably went all over her face, but I didn't tell her. Anyway, I had been holding her pain meds because her blood pressure was too low even though she had been trying her very hardest to persuade me that it was ok. I could not be convinced, however, because as she was trying to talk me into it, she was almost falling off the stretcher. Finally her IV fluid bolus completed, and her pressure was better, so I really had no reason to deny her another fix. But, in a ironic twist of fate, I went to give it to her and her IV had come dislodged from the vein.

She cried out, "No, don't do this to me, not now! Come on, this can't happen, this can't happen." I said, "It did happen, and I will have to look for another place to put one." I knew full well that it would be a challenge, since the one that they had was an infant-size IV. All of her veins were shot from what appeared to be years of IV drug abuse. She then vehemently begins pointing to some blue squiggle of a vein near her armpit. What a mess. At that moment, I was paged to go to another one of my rooms to receive an ambulance patient. Ah-hah! another twist of fate in my favor.

On my way out, I asked one of our techs to go take a look for an IV. Apparently she did get it, and, as the patient informed me when I went back in the room, "she got it a LONG time ago." 2mg Dilaudid IVP q30 min, coming right up.

After I finally got patient #1 to leave, I saw that there was a giant (and I mean giant) red suitcase sitting right in between the hallway of where pt #1 was, and the room where pt #2 was. Pt #1 was gone, and I wasn't sure who it belonged to, so I forced pt #2 to come out of her coma for just a minute and asked her if it the bag belonged to her.

She looked at it, scrutinized it and reached for it, and tried to look inside. I said again, "Is this giant red bag yours or not?" I thought, you shouldn't need to sift through it to know, either it was yours or not. She finally decided that it was not, and returned to her coma.

I think I'd rather have patients addicted to crack or heroin than the Dilaudid crowd.... I don't know why the docs are surprised/irritated that they keep coming back. If you feed a stray cat you will never get rid of it!!!

Hello midnight

2010-08-03T14:50:00.000-07:00

I will be seeing a lot more of you. For those of you who don't know, I am going back to night shift at work. Combine that with my much-overdue raise and I'm looking at about $800 more per month by working the same amount of hours. New schedule starts September 12!

Work has been interesting recently, and by interesting, I mean off the hook. Out of control. Patients in every stretcher and hallway and chair and corner we can fit them. A new manager patrolling the unit looking for "ways to improve." Coworkers quitting left and right. Lots of new grads coming. Should make for some more interesting blog posts...

Still doing a lot of thinking about stuff, still doing a lot of crying and worrying. Still trying not to admit that I'm a mess inside. Really trying to focus on the beauty of life and experiencing and enjoying it the way I want to. I think I spent too much time planning and worrying about the future that I forgot to enjoy today, this time, right now. I am getting better at that.

Trying to get myself out to the gym today... It's hard when I've been laying around all day in my pajamas. Nice to have this kind of a day every now and then. Still, I think I will get out and burn off some calories in time to come home and watch all the Without a Trace that I've DVR'd.

Ok, here I go..... time to break into a sweat!

Just sit with me tonight...

2010-07-21T19:58:00.000-07:00

Sometimes what you don't say
Makes all the difference.
Sometimes you find your own way
Without interference.

It's not all darkness
it's not all light
You don't have to fix this
Sit with me tonight.

The sound of our breathing
in the TV light
I don't want to fight it
Just sit with me tonight.

We pray for acceptance
we pray for deliverance
we pray for understanding
Like it makes all the difference,

It's not all the way left
it's not all right
you don't have to fix this
just sit with me tonight.

The sound of our breathing
in the TV light
I don't want to fight it
Just sit with me tonight.

More letters!

2010-07-12T07:28:00.000-07:00

RN,, with BLS, ACLS, PALS, TNCC! Next up: ENPC and CEN!

I passed my TNCC (for all my non-nursing people, that is a trauma nursing certification). I am so happy! I have been sick in one way or another for about 2 weeks so wasn't sure if I'd make it through the class but I did it!

Got pretty choked up when they were showing some pix and discussing MVC's (motor vehicle crashes) and about extricating people from cars. Kept thinking about our friend who died just like that, guess it is still fresh. I think about him every day. Have been spending some good quality time with his wife and really enjoying getting to know her better and LOVING spending time with the triplets. I think it has really helped the healing process, to see that no matter how painful the situation is, the human spirit can still carry on. No matter what God has allowed us to go through, we are not going through it alone. Still, I can't believe he is not around to know his baby girls and watch them and his son grow up. I am still wrestling with a lot of questions for God.

Still, I feel like this class will make be a better nurse, whether I'm caring for trauma patients or critical medical patients. It has reinforced to me that I am doing something that I am good at. Sometimes I'm not sure if I chose ER or if it chose me.. but either way, we have a dysfunctional love/hate relationship that I think will last a long time. Whether I like it or not, I am good at this and to sit in an office taking blood pressures would be a waste of talent. After the traumatic death of our friend, I really questioned whether or not I could continue working in ER or pursuing a career in trauma. I have come to terms with the fact that every day, you are a part of somebody else's worst day ever. I understand that I have seen and will continue to see things that nobody wants to imagine.

I cannot get the image of the trauma patient being my husband or somebody I know out of my head... these thoughts plague me when I'm awake and in my dreams. I hope that time will lessen these thoughts. Maybe that explains why I am obsessively taking every class and practicing and reading so I can be better and better. I also know that while trauma can be exciting, it can also be horrific; but you don't routinely know the person on the stretcher, so you can compartmentalize it and get through it. Either way, I'm sure my patients will appreciate the fruits of my obsession.

Sometimes I wonder

2010-06-25T19:06:00.000-07:00

where my life is heading...

been looking a lot at photos of people that were taken from us way too soon... nobody would have ever thought those would be the last pictures ever taken.

I remember the following quote from a long time ago, and thought it was particularly appropriate tonight.

*When you see such photos, you can't help but wonder at just how sweet and sad and innocent all moments of life are rendered by the tripping of a camera's shutter, for at that point the future is still unknown and has yet to hurt us." Douglas Coupland

Sometimes I just want to press rewind, curl up on my mom's bed and have her tell me everything is ok, and be able to actually believe her.

The dangerous summer

2010-06-18T21:01:00.000-07:00

has begun.

As you can tell if you read this blog at all, I spend a fair amount of time working in the peds ER. Most days I honestly don't mind, when we have sick kids. We have had our fair share of pediatric tragedies recently...

a 10-month old pediatric code...

a 21-month old little boy who got into Grandpa's BP meds... somehow got ahold of Norvasc, Labetalol and Clonidine. Kid tanked right before my eyes but was holding steady off of pressors at time of transfer...

an 8 year old little girl who choked on a grape on her last day of school. I don't know why nobody knew the Heimlich, but by the time EMS arrived, apparently she was pulseless. Eventually they did get a pulse back, but pupils were fixed and dilated, which equals serious brain injury. She was flown out to Children's with a pretty poor prognosis.

Kind of hard to deal with this stuff and then go back to all the regular pediatric foolishness... my kid has had a fever for 1 hour, but I didn't take her temperature and no, I haven't given her any Motrin or Tylenol.. no I don't even own any.

Um.... WHAT?!!?!?!!! How about you go home and be a parent and come back when your kid is actually sick??

Nothing to lose but everything to gain...

2010-06-14T11:38:00.000-07:00

I am still troubled with dreams of getting that phone call, that knock on the door, telling me that my life will never be the same. I go to bed and think, will this be the night that one of my friends will come tell me that my husband isn't coming home? Every time I'm at work when he's working and they bring in a code, I can't help but have a slight moment of panic and pray a silent prayer that it isn't him... I sleep with the volume on my phone turned all the way up, just in case. Goodbyes are meaningful and "I love you's" are more frequent. I wonder every time he leaves if that will be last time I will ever see him or hold him or kiss him... it is tormenting.

Part of me wants things to go back to "normal," but at the same time, I have developed a new sense of purpose. I have decided that I will really live with no fear, no apologies, no regrets. I will not let others dictate my importance, I will not apologize for doing what I want, and I will not apologize for saying 'no' to the things I don't want to do! I will live to the fullest, I will love outrageously and without abandon, I will make time TODAY for the things that are important.

As sorry as I am that I had to learn the hard way, I am grateful for the ability to see life as the precious gift that it truly is, and to know that every plan and hope and dream you have for your life can be snatched away in an instant. Do not delay the things you want because we are not guaranteed tomorrow.

That being said, I have some tough decisions to make in the near future... *sigh*

Today was one of those days

2010-06-01T21:54:00.001-07:00

that makes you want to turn in your nursing license and run in the opposite direction!!!

Peds peds and more peds

2010-05-25T09:06:00.000-07:00

After being out of peds for some time, I had the pleasure of being there back to back Sunday and Monday shifts.

I am not being sarcastic; really I don't mind going to peds. What I mind is running around crazy for 12 hours bc mom doesn't know what "this rash is that my son got after he was playing outside" so she brings her child to the EMERGENCY room for us to tell her that it's poison ivy.

I did have a couple of sick kids... 17 y/o with spontaneous pneumothorax and a 13 y/o that needed an emergency circumcision ( I will spare you all the details).

I also had the pleasure of standing underneath the hot lamp for an hour assisting a plastic surgeon as he repaired a nasty through-and-through lac to the a kid's cheek. He fell off his bike and the handlebar went through his face... This was particularly challenging bc I was taller than the surgeon so I had to lean over the whole time.

Off today, somehow I thought it was a good idea to pick up hours tomorrow. oh well, it's only 8 hours so it's no big deal!

And I try not think he won't come home...

2010-05-22T20:59:00.000-07:00

but I'm sleeping with the telephone on.

If only

2010-05-13T16:55:00.000-07:00

the doctor would have performed an emergency tonsillectomy on the FF psych patient, we could have avoided the choking of a tech, the flailing around, the yelling of profanity, the calling of "Code Green", the dragging of the patient out through the waiting room, the calling of police to take her off of the property, and the threats that she was going to send Tiffany (whoever that is) to come back and wreak havoc on us.

See, the patient sts she was diagnosed with an ear problem a year ago and the "only cure" was an "immediate tonsillectomy." Hhhmm.. somehow a tonsillectomy does not seem like the kind of thing you need to have done immediately.

In other news, last night a patient's son told me "I'm glad my mom didn't get sick last night, I would have missed Lost!" Son - it's time to check yourself.

Ashy

2010-04-28T08:06:00.000-07:00

I went upstairs to our urgent care/fast track area to help out the nurse there because she was really busy. At one point, I was discharging a patient who was 16 so I asked the mother to sign the discharge papers. As I am finishing up the instructions, she (no joke) pulls out some lotion and says "I got to rub this on my ashy feet real quick like." She proceeds to rub it all over her feet as I sit in dumbfounded silence. My awe was only intensified as she then reached for my pen with her ashy-foot-lotion hands, signed the paper, then gave me the nasty pen back!!!

Umm... no

2010-04-20T21:48:00.000-07:00

Patient: pointing to arm, approx 1/2" to the left of the IV, states "Nurse, could you move the IV to this vein?"

Nurse: um, no.

RIP

2010-04-10T08:22:00.000-07:00

One of hubby's partners was killed in the line of duty this week. SO incredibly tough to deal with. There are a lot of "what-if's" floating around my head right now bc he was supposed to be working but got off at the last minute so we could go on vacation early.

Needless to say this has been a horrible week full of the whole range of human emotion. The funeral was yesterday. The support from their department and departments state and nation-wide was amazing.

-----------------------------------------------------------------------------------

We laid you to rest with a true hero's sendoff. What a beautiful tribute to a man who was loved by so many. The support from MCPD and other departments was both overwhelming and humbling. The 10 mile long processional of police vehicles was so moving as we traveled from the church to the burial site. I know you have left a void in the hearts of your shift mates that will never be filled.

Though your unborn children will not know you, we will make sure that they will know of you. Even though they lost their father and nothing can ever replace you, they will know how much you loved them even without meeting them. Your wife, Jr. and the unborn three will be taken care of. Just like we could always count on you, you can count on us.

Goodbye, dear friend. You are 10-7 for the remainder.

R.I.P

2010-04-04T11:06:00.000-07:00

Didn't want to believe the news when I heard. Couldn't believe it. Still can't.

May you forever R.I.P - and in your favorite words, that's a wrap.

Untitled #2

2010-03-11T01:39:00.000-08:00

More and more I am not able to truly articulate some kind of title that is covers the spectrum of the shift.

Today there was an obese drunk man with his belly out making out with his brother/boyfriend/husband in the hallway (apparently "he's everything to me"), then he decided to pee all over the floor in front of the nurse's station.

Also, apparently being "tired" is a reason to call 911 now. Go ahead and open your eyes sister, you can stop pretending to be unconscious. I saw you swallow.

*Sigh* Off 2 days in a row. How many more days until part-time??????

untitled

2010-02-28T10:09:00.000-08:00

this blog entry is untitled bc my brain is too fried to come up with a title.

This was an interesting week.. Monday I sat in the cage known as triage, pretty bad day as far as patient waits, lots of reminding people that patients are called in order of medical need, not by arrival time. Side note- if you're having a nosebleed, don't just hold a towel under your nose and let it run out. Please squeeze the bridge of your nose. People thought I was a ------ for not getting this guy into a room. what for? no anticoagulant use and I'd told him already 3+ times (and shown him how) to hold pressure to stop the bleeding, and every time I looked over at him, he's holding the towel under his nose. *sigh* Some people like drama.

Tuesday, 8 hours OT in peds, not a bad day at all. Reeeaaalllly slow in the beginning, seeing as how we had 2 RN's, a peds triage RN, a med student, a paramedic student, a tech and an orienting tech for our 9 bed department, which at no point was full.

Wednesday I took a patient assignment which is nice to do every once in awhile. Kind of nice to just have your 4 patients and that's it! It was very refreshing to just do your thing and get out.

12 hours on yesterday, covering everybody for lunches, triaging ambos, helping out with a C-port and ended up starting a pt on Lidocaine and Amiodarone drips before finally cardioverting him. Then he lost his airway, which was not so fun, but basically everyone in the department was in the room, so the airway issue was quickly resolved!

Off today, catching up on life stuff, gym, studying.. got a Stats test Friday and I work Mon,Tues,Wed, so gonna need to do some studying today!

Dear mom

2010-02-22T21:52:00.000-08:00

(and no, not to my mom, to a patient's mother)

I guess you were too busy getting your gold caps put on your teeth to learn how to be a mother. I thought you had gotten yourself together when you said via the Spanish translator that you took your 13 month old to the doctor's office today who gave him saline nose drops and a cold diagnosis. Where you really went wrong is calling 911 at 11pm for a medic unit to come out for "pediatric respiratory distress." As your child is laughing and playing in the triage area, I am not-so-secretly hating you.

The end.

Snoop D-o-double gizzle

2010-02-22T06:35:00.001-08:00

was at the Cross this week! Or at least, his twin was, with his girlfriend who came in for altered mental status. In his words, she became "all jacked up" after dinner. Never really got a good explanation for what that meant exactly. I did get the impression that she was significantly altered, initially appearing post-ictal without any hx seizures. Snoopy here was hell-bent on the idea that she had gotten that "N1" virus from her sister's "germy-butt kids." *Sigh*

Boyfriend was so irritated that he had to call 911 bc "he had to take his hair out of the curlers." Not to worry, folks, he proceeded to re-braid it in the short time he was in the room before he decided to use an empty hallway stretcher to take a nap. Usually I intervene in this kind of bold behavior but he was driving me crazy so I just let him sleep. Turns out she went into acute renal failure, complicated with urosepsis. That would certainly explain the temperature of 104.3.

Also yesterday had a very sweet lady whose pulse was 27. The ticker was not so effective. Pacer pads on, waiting for the word from the doc. Turns out that she did not get paced, but they did but a subclavian triple lumen just in case they needed to drop some transvenous pacing wires in.

Off yesterday, back today for 3 more in a row.... bring on some OT money!

Monday, Monday

2010-01-26T06:30:00.000-08:00

typical overcrowding, understaffing.... took a patient assignment for the first time in awhile. it was kind of nice to just have my 4 rooms to worry about.

coded a lady in the parking lot, that was fun. we couldn't figure out how to get her out of the wheelchair van. Once we got her out, got her into the room, we got her back! score one for the home team!

Later on, the intensivist came to write her admission orders. He asked me what happened, so I told him the story. After congratulating me on "resurrecting her", he then asked if I thought she was in respiratory failure and I said yes. Then he asked if I thought she needed dialysis and I said yes. He said "ok" and left.

ummmm..... what????? aren't you the doctor??????

and the beat goes on.

This one goes out to all the fatties.

2010-01-10T09:10:00.000-08:00

Why do you make so much more work for me?

Example #1 - 450lb lady who called 911 for her abdominal pain. She came from some kind of shelter/halfway house I guess.... She was already there when my shift started. I took report from the other nurse who told me that all she needed was to give a urine sample and that likely she'd be discharged as soon as that came back since all the other tests were normal.

10 hours later (yes, 10) and several failed attempts later, I had the opportunity to dive into the nasty folds of obesity to do a straight catheterization to get the above-mentioned urine sample as she "just couldn't go." I will not elaborate further on this as it was traumatizing even for me. We had to go this route because I refused to hold the cup for her so she could hold up her GIGANTIC stomach. She got CT contrast and if you have ever taken oral contrast, you know why I did not want to get my bare arm anywhere near that.

Over the course of these 10 hours, I probably told her 50 times that she could not eat until we had all the tests back. She also repeatedly asked for a cab voucher so she could get home. I told her that we do not do cab vouchers but that we could give her a bus token to catch the Metro bus. She refused this every time I offered. She then accused me of not giving it to her bc she was black and bc I didn't like her. While the latter was true, I told her I couldn't give her something I didn't have to give. Then she wanted to speak with my supervisor who very quickly told her the same thing.

At this point, she was refusing to leave. I told her she had been discharged from the hospital and had to leave. She again asked me for a cab voucher. I again said no. She then got angry and decided to drop the gown and walk to the bathroom stark naked. That was a sight nobody wanted to see. Then she came back around and sat down dressed and asked some innocent bystander to get her nurse for her. She asked again for a cab voucher. I gave her 2 bus tokens and reminded her that we don't have cab vouchers. She still refused to go. I promptly called security to get her out of there. I could not deal with her anymore. Security escorted her to the waiting room where she can leave or not leave or find a ride or not, I didn't care. Then the security guard came back and found me and asked for a cab voucher or a bus token for her. I told him I ALREADY GAVE HER 2 BUS TOKENS. OH MY GOSH PEOPLE!!!!!!!!!! This was like the patient from hell. I barely managed to get her out by the end of my 12 hour shift. By the way, all the tests were normal so all of this was a waste!!!

Example #2 (for all of you have made it this far): Last night I was floating at work, which means that I just cover people for lunch, respond to the Stat team calls from the ground-2nd floors, respond to codes, strokes, STEMI's.... I had literally just finished running back-to-back codes (I hadn't even finished pulling the sheet over the one when I hear the alert go out again...) Anyway, I was finishing up my charting on both codes when one of the peds nurses came over and begged for me to come try a hard-stick in peds.

I say sure, why not? I will stick anybody and most times I can get it, even in Peds. She directs me to the room where I find the fattest baby I have EVER seen. 4 months old and 25 POUNDS. For all of you who don't know baby weights and things, a baby should be twice their birth weight at 6 months and 3 times their birth weight at a year.

This baby was 7 lbs at birth, so she shouldn't even have been 14 lbs. The extra 11 pounds were stored as pure fat. She had thighs that rivaled Tanya Harding. This child had so much fat tissue that the peds nurses stuck her 5 times and couldn't even get blood.

3 tries later and I got a working IV and blood but still, I could not believe how disgusting it was. At this rate she'll be 50 lbs at 1 year old! She won't even be able to develop because she won't have the muscle strength to support all that extra weight. Sad.....

And that is the summary of my ode of anger to the fatties.

I should have known

2009-12-29T10:55:00.000-08:00

that work was going to be bad yesterday. First and foremost, it was Monday in the ER. Unfailinginly this the worst day to work. I should have really known it when I get to work and the charge nurse says to me and another co-worker "Hey can you guys do me a favor?" We asked "What is the favor?" She then asks us to go bag and tag a body. Groaningly we oblige. Then we find out that this is not your typical bag/tag job. This is a 9 month old baby girl. Sadness. What an awful start to your day.

Then I got sent to Peds which I don't mind every now and again. Then I got sent to our version of fast-track. Then I came back down and went to triage. Definitely crazy. We have a 10 minute window to get an EKG on everybody who has chest pain. OUr triage area has 3 beds for EKG's. At any given point I had 5 or 6 people back there and more chest pain people waiting.

On a happier note, I am basically off for 4 days! I have to work 4 hours on Thursday but I don't care about that at all. It doesn't count. :)

Untitled

2009-12-17T21:57:00.000-08:00

Couldn't think if a way to title this weirdness.

19 y/o M complains of general weakness for a week, no energy, poor appetite and "taste bud changes." How did he test it out? After I cleaned the IV site with Chloraprep, he decided to lick it and see if he could taste it.

What on earth.

People have a lot of nerve....

2009-12-14T09:56:00.000-08:00

and no modesty. These things are a bad combination that turned particularly unfortunate for me this week. I came out of patient's room and found a patient wearing ONLY a hospital gown (i.e. no underwear) sitting at my desk checking her email and talking on the phone. I promptly ended the web browsing and the conversation and got myself a new chair. DISGUSTING. This is the same person who asked me to send all her calls to her while she was in xray. She got a ton of calls. I answered none of them.

As if that weren't enough, somehow I got roped into doing 4 hours of peds triage. This becomes quite difficult when out of 20 kids I did in 2 hours, only 2 or 3 sets of parents spoke English. My personal favorite was "My son has a fever." When I ask how high, the parents say "97." I did not know what to type as my triage. Chief-complaint: non-fever. :) Did see 2 really sick kids. 8 weeker with room air sats of 79% who ended up going to NICU and a 2 week old baby with a *real* fever who bought himself a full sepsis work-up including a lumbar puncture after the WBC's came back @ 20k.

Off for 3 days, getting geared up for the hubby's Christmas party that we are hosting. Should be interesting to say the least!

Things not to do while you're pregnant.

2009-11-19T16:37:00.001-08:00

1) Come to the ER and say "I was bleeding 2 days ago, but it stopped now. Now I want to get it checked out." (We can't evaluate a problem that happened 2 days ago.)

2) Come to the ER and say "I'm 35 wks pregnant and I haven't felt the baby move for a week." (Why would people wait an entire week???)

3) Come to the ER and say "I'm 8 wks pregnant and I haven't felt the baby move for a week." (You are just having gas, sweetheart).

4) Come to the ER as a visitor and fall out on the floor seizing. This should be pretty obvious. If you end up as #4 and are in fact in status seizures for an hour, you may find yourself intubated and sedated on anti-convulsant drips while the father of your baby is cheering on the Redskins in the waiting room.

Where am I? What happened?

2009-10-26T08:43:00.001-07:00

This is what my patient with Transient Global Amnesia asked me about 40 times in the course of the 30 minutes I had her in triage. I did her initial triage, EKG, IV, etc... and about every 2 minutes she would re-set and go back to asking "Why am I here?" "What happened to me?" "Why am I in a hospital?"

The crazy thing is, she knew who she was, she knew her birthday but then when I asked her how old she was she couldn't remember. She knew her SSN but not her son's name.

Apparently about 4 hours later she was still asking the primary nurse the same questions!

Weird.

Jinxed!!

2009-10-07T21:48:00.000-07:00

That is what I did to myself. I jinxed myself. Just when I said work had been boring.

Today I spent 12 hours in triage/assessment area. Wasn't too bad up till about 5pm. Then it's like the sick bus rolled up and dumped everybody out at the front door. I had the following in about 5 hours:

-91 M, total self-care, walkie-talkie, living at home patient, tripped and fell. Turned out (thanks to Coumadin) that he ended up with a major intracranial hemorrhage. When I left he was circling the drain and the code cart was being wheeled to his room.

-26 F 12 wks preg with vag bleeding and abd pain, ended up with an IUFD (intrauterine fetal demise). No more baby.

-26 M headache that ended up being brain tumor.

-44 M blurred vision that ended up being brain mass.

-55 F without any other medical problems came in and ended up having a heart attack.

-65 M who tripped and fell and ended up with a subdural hematoma with midline shift.

-67 F came in for chest pain and had labs so out of whack that she might have leukemia.

So.. I saw all the above plus about 150 more. All of that equals bad news. The triage doc and I kept saying that we were little black rain clouds of bad news.

It's a hard day when all these people find out some pretty devastating things when they all thought their symptoms to be pretty harmless. and the worst thing of all? I'm going to climb in my bed, sleep like a baby and probably not think of these people again. Does that make me a bad person???

Boo

2009-10-05T15:38:00.001-07:00

Nothing fun ever happens on day shift. My orientee is on her own now, I have to do all my own work!!!

How much longer until I can go PRN? Oh yeah, I just signed another year's contract. 11 months to go.

I took her by to say goodbye...

2009-09-19T21:43:00.000-07:00

88 y/o F, cc: weakness. Pt states she was depressed because she was "under a lot of stress." Come to find out she and her husband, who was basically on death's door, were just separated for the first time in 65 years when she moved into a nursing home. She recently made herself a DNR. Our doc wanted to keep her for short-stay tele b/c her BP was high. We found out that her husband was not doing well and asked for a bed for her on the same unit if possible.

I had the duty of taking her upstairs... and decided I was going to take her by to see her husband. I scoped out the situation prior to taking her in and I decided that it was good thing I brought her by... I do not think he's going to make it out of the hospital.

It was so beautiful, I almost cried. She just sat there next to his bed in the wheelchair that I brought her up in, just holding his hand and telling him how much she loves him, how sorry she was that they fought the last time that they spoke, how she would always love him...... she just stroked his hand. The whole time he never woke up or even responded to her.

It was so sad... I can't imagine how hard it must be to get older and really accept your own mortality and to accept that things are never going to be the same again. It really makes you appreciate what you have and the people who love you.

Some people...

2009-09-16T22:02:00.000-07:00

worry me. How could you have a gun shot wound through your eye and into your brain and claim you didn't know you had it? Weren't you wondering what the heck happened to your eye?

And seriously, why would you say you didn't know? Do you think we're stupid? Just tell us the truth about what happened, let the cops sort out the rest.

The 1st cop and the detective that came to investigate the case before the patient got shipped out for brain surgery were both guys I knew.. one was a guy I worked a trauma code with and the other guy is a friend of my husband and we were all sitting there going "what on earth is going on with this guy?.... Needless to say, it was a very weird situation.

While I was taking care of that patient, EMS brought me a 79 y/o F with trouble breathing. Too bad she skipped her dialysis today and was fluid-overloaded. I have no sympathy for these people. She asked me why "it took you so long to get to her. I told her I'd been busy with a guy who got shot in the head. She asked, very annoyed, "does it take all the nurses for that?" I said "Have you ever seen a gun shot wound to the head?" When she nodded no, I said "IF you had, you would know why it took me so long." THen she was refusing to let me put an IV in. I told her that the doctor really wanted her to have this IV and if she didn't let me try that he would come put one in her neck. She panicked but did not let me try. I had patients who would like to cooperate and be treated and if she would not like to do so she could leave. She didn't like that too much. Oh well. New doc on the unit came by and said he'd try.. then again I had to show him how to use the IV cannula so I'm pretty sure that was a no-go.

Anyhow, I'm home and ready to hit the sack before 8 hrs OT tomorrow.

Well, she finally did it...

2009-09-08T20:48:00.000-07:00

A FF (frequent flier) who I cared for multiple times after multiple suicide attempts (OD'd on her psych meds and washed them down with alcohol) came in the other night as a code. I wasn't there but I heard that they coded her for some time but were unsuccessful in resuscitation. She was in her mid-40's. Apparently she came in looking like her face had been in a boxing match - her family thought the husband was to blame so apparently they barred him from even coming back into the room during the code. I saw them interact multiple times and as trying as she was, I really got the impression that he loved her. I think she liked being in distress and he liked rescuing her. Too bad he couldn't rescue her this time.

RIP.

Never knew blood could fly so far.....

2009-08-24T22:21:00.001-07:00

well, that's a lie. I did KNOW it could, I had never seen it. 22y/o M, GI bleeding with previous dx cirrhosis and splenomegaly, presents w/ vomit in blood and stool. Most of these young patients who say this stuff usually have a couple of flecks in their vomit, nothing big.

When I tried to put the NG tube down his nose for irrigation, he promptly began SPEWING blood. I mean, like a geyser. Everywhere. Had to call housekeeping for a new curtain.

Had a sad lady yesterday... 58 y/o F, stage 4 neuroendocrine Ca, new onset seizures. We had to be the ones to tell her that she has mets to the brain. I hate giving bad news in the ER - it really should come from the patient's doctor. It is so impersonal, not enough time to even digest the information and you're either upstairs or out the door.

Have a new orientee with me for a month.. she has previous ICU experience. She is too thorough for her own good. She was taking everybody's socks off and checking their pedal pulses... This is going to be an adjustment for her.

Yes, everything's fine and thanks for asking

2009-08-18T20:49:00.000-07:00

I know that I've blogged about this before but for some reason it is weighing on my mind again tonight....

I have been thinking a lot tonight about ER nursing. Nursing in general is really hard but I guess I will always be a little partial to ER and trauma nurses because it's my first love. I can relate to that particular struggle. Sometimes I get in the car at the end of the shift and just laugh. A few times I have gotten teary on the way home. Sometimes I can't believe what I have witnessed.

Some things are funny - the idiosyncrasies of patients, their families, staff dynamics... and a lot of time is spent laughing.

But there are a lot of quiet moments. Some things are so sad...the 2 year old whose mom found him not breathing and tried for 45 minutes to wake him up before calling 911, the too-young woman who died with only her 12 year old son there, the devastating stroke that was brought in too late, the family man who collapsed and died playing basketball with his son, the 18 year old who fell off a 2nd story balcony and had serious brain injury, the 30 year old who was awake and alert one minute, coding the next.... to the John Doe who is torn and shredded, just a shell of some unknown man? What about the woman who is 2 days post-partum in cardiac arrest? What about the patients who have forever to suffer because of the bad choices of somebody else? What about the 30 year old patient, trached and vent-dependent after he was stabbed?

To the dreaded diagnosis of a life-altering disease.... how do you respond to 20 year old girl that just found out she has a brain tumor? How do you tell the 27 year old that he actually has advanced HIV? How do you tell a patient's children that their father's cancer has spread and that there is no hope... When asking a patient if you can get him anything else, what do you say when he asks for a new pair of lungs? What do you say to a woman who desperately wants children and is instead having her 5th miscarriage?

I guess it gets old being a part of the worst day of people's lives. And it can be so hard knowing that you cannot save everyone. You clock in, work 12 long hours, clock out and go home. No matter how much we may try to justify and rationalize, nursing is not just a job. Sometimes it's easy to forget that you are really in a life-and-death job until it hits you in the face. I'm tired of being hit in the face.

NTP

2009-08-17T16:03:00.001-07:00

This was listed in the comment section on our patient tracker board for one of the patients yesterday. What did this mean, I asked? Need to poop. Hhhm.

Funny how this 44 y/o M needed 4 or 5 enemas (not my patient, thank GOD). Funny how he loitered around for 18 (yes, EIGHTEEN) hours waiting to poop. Funny how he "forgot" his mom's phone number so he didn't have anybody to come pick him up.

NOT so funny when they finally were able to discharge him to the waiting room to leave or not leave or to do whatever he was going to do, he pooped all over himself in the wheelchair. This is a man who could have walked to the bathroom with his cane.

Funny how the charge nurse wheeled him in the bathroom and gave him all the stuff to clean himself up. He wanted us to do it. What a disgusting pig.

Man vs. car

2009-08-15T22:16:00.000-07:00

Man: shattered jaw, free-floating mandible, shredded tongue, open humerus fracture, multiple contusions to abdomen, open tib/fib fracture and left hip fracture.

Car: not so much.

= sad ending with a "john doe" to the morgue.

Goodbye night shift

2009-08-08T23:38:00.001-07:00

You have been such an interesting orientation to ED nursing, with your pirates and shemales and frequent fliers. I will not miss the lack of sleep, lack of staff, lack of resources available during those hours. I will indeed miss Francene's 3am candy, tag-teaming every nursing home dump like a well-oiled machine, and the feeling that you are part of a secret task force, working hard to make sure the world is ok for people when they wake up. I will miss working with such a great and diverse group of nurses who are very giving and always willing to answer a question or lend a helping hand. And I will miss my differential...

At the same time, I am looking forward to having for the first time in my life, a "normal" job. I say normal because now I will still be working until 11pm, including weekends and holidays, but no more staying awake until 8am on your nights off because you are so turned around. No more 2 hours of sleep because you have to run errands during normal business hours, no more getting upset when people call you and interrupt your sleep. It will be interesting to see how it pans out with my husband still on night shift but he is really supportive and has been encouraging me to make a change.

Starting Tuesday I'll be back in the swing of things..... now if I can only convince my body that it's time for bed, I'll be off to a good start!

Things NOT to do list:

2009-08-04T22:42:00.000-07:00

1. Don't reach under the lawnmower while it's turned on and the blades are going. You will a) leave yourself eternally maimed and 2) force me to call the OR in search of something called a bone cutter.

2. Don't drink too much, sit on the trunk of a car and let your equally drunk friends get behind the wheel and take off with you sitting on the trunk. You just may end up with a traumatic subarachnoid hemorrhage, closed head injury and a skull fracture.

3) Don't bring your 2 year old to the ER at 0230 for his 3rd of 5 rabies shots. I'm pretty sure it could wait until normal business hours.

4) Pop a baby out in the bathtub and claim you didn't know you were pregnant.

5) Smoke some marijuana, drink, pass out behind the wheel. This is even worse if you look like a leftover from Wayne's World. And don't ask me again what hospital you're in.

To most of us, this is common sense. It's the rest of the nutballs that keep me busy all night!

Arg...

2009-08-03T03:37:00.000-07:00

there was a pirate at work last night. This pirate was coming to visit a patient. Completely dressed in authentic pirate gear, including the fake bird on his shoulder. What on earth he was doing wandering around the Hispanic ghetto @ 2am I cannot even begin to guess.

Codes, codes and more codes

2009-08-01T13:38:00.000-07:00

is a fair way of describing last night. 5 codes in 5 hours. First one was a 29 y/o M, diabetic, noncompliant, found down at home, unresponsive, asystolic, covered with vomit. Brought him in, we were able to resuscitate him, but he was in severe diabetic ketoacidosis. ph of 6.99. His EKG showed the worst DKA I've ever seen! Wide complex tachycardia, severely elevated T waves (Potassium was 10!). I yanked a new grad (2nd day on the unit) and told her she was goign to stand with me ( I was documenting the code) and I was going to explain everything that was going on. I think I overwhelmed her.

Again I was thinking about how much I've learned in my one year as a nurse! When you first come out of school you are so task-oriented. Now I am able to really think through the disease process and anticpate what the doc is going to order and what to assess in the patients.

That was the only interesting code.. the rest were just old people that the families couldn't let go of... if you have read any more of this blog you know how I feel about that!!! Thankfully the family of the 95 year old who had been resuscitated once decided not to take action when he lost pulse again. It torture to keep somebody trapped in that shell of a body.

I spent another 12 hours in Peds ER last night..... UGH im so tired of it. In all actuality I don't hate Peds but I hate that nobody else will go. I don't volunteer to go but because they know I'm willing to go and I do a good job over there, I get abused! I've been over there 6 times in the last 3 weeks. The weekend charge RN is the only one who ever puts me over there. We were so busy, and short staffed that they adult acute nurses had 6 patient assignments, telemetry admits in the hallways w/o monitors, and a waiting room jam packed. At one point the charge nurse went out and made an announcement to the waiting room and said "If you are here you will be waiting 5 hours to see a doctor." Half of them left. Guess that shows how sick they were...

Technically off tonight, but I might go in for 4 hours because I'm trying to pick up some OT. That means I will have 30 hours of OT on my neck paycheck!!!! Sweet - I'm buying myself a new dining room table!

uh-oh....

2009-07-30T17:29:00.000-07:00

cracked the code cart for a 51 y/o M who collapsed in the shower.... no Epi or Atropine in the cart. Somebody from pharmacy screwed up BIG time! Unfortunately he was in PEA (pulseless electrical activity) so it wasn't going to do much good for him. Still though, that is a BIG uh-oh....

We were on red alert (aka code red, aka the hospital is FULL TO THE MAX) Monday night and a good part of Tuesday night. The same patients were stuck in the ED for almost 24 hours. I'm sure most of them didn't get their routine meds, everybody was tired of box lunches, everybody wanted pillows.. and all of the staff wanted to shoot ourselves! There is a reason we went to ED - we don't want to deal with you if you are well enough to complain! :) If that blind, HIV, crippled man called out "nurse" to me again or told me one more time that "the bedpan is too small" (I mean, what was he planning on doing???), there would have been a crime committed!

One more week of night shift, then going to 11a-11p.... I'm not sure right now if I'm going to like it but I know that it'll be much easier to manage school and full-time work when I'm not sleeping all day.

another batch of new grads started yesterday - I can't believe how much I've learned in this one year!!!! Hard to believe that just a year ago I was fresh out of school, had never done CPR, never run a code, never cared for ICU patients... I had never even had to ask a doctor a question before I graduated! Life is so different now but I'm so glad! Even more glad to be off tonight.... :)

More tomorrow, I'm sure!

It gets weirder and weirder every night....

2009-07-04T21:52:00.001-07:00

From the girl whose boyfriend accidentally shot her in the eye w/ a BB gun, to her incredibly calm and relaxed parents (mine would have been livid!!!)....

to the girl w/ seizures (who oddly enough looked like a guy - i'm seeing a lot of this lately) who needed an MRI but couldn't go b/c she was wearing her ankle monitoring house-arrest bracelet....

to the 66 y/o guy that came in feeling hot and dizzy after taking a couple extra Viagra...

to the people that came in panicking because they vomited once....

to the girl in the hallway with the earache who was asking for a private room because she felt "disrespected" in the hallway... yeah right, lady, we are on code red!

Gotta say..... i love it!

DUI's, codes and weirdos

2009-07-01T16:43:00.001-07:00

Pretty much the summary of last night.

It started out decently enough.. not terribly busy, and I was the "float nurse." the job of a float nurse is to transport monitored patients (telemetry or intensive care) to their inpatient rooms and occasionally off the unit for testing. Last night the hospital was pretty full, so we weren't getting very many beds for our patients in the ED waiting to go upstairs. I just floated around helping out here and there.

At 11, I took an assignment. Shortly after I moved a patient that needed respiratory isolation into a private room (after he'd been sitting in the waiting room for several hours), I got what we like to refer to as a "nursing home dump." EMS called it in as "abnormal labs" - why they sent the patient in for abnormal labs 15 hours after the lab slips came back is beyond me. She was a trached, vent-dependent patient. She was awake, would follow you with her eyes but was basically just a shell of a body. No response to commands, no response to painful stimuli.... of course she needed everything done. And I HATE trachs.... particularly suctioning them. Not as bad when they come w/ in-line suction set up but still... not my thing.

Just as I'm getting settled with her, my other patient whose BP was 225/116 and the guy with new onset CHF, I hear a bunch of commotion coming through the ambo bay. Turns out it is police coming in w/ some out of control lady they pulled over for DUI who needed to get a blood alcohol kit done. She is screaming, flailing, accusing, etc.... and not wearing any pants. She is fighting the police.. while the charge nurse is trying to figure out what to do with her, the patient decides she needs to pee. She walks into the bathroom, escorted still by the female officer, and is screaming and hollering for them to "let her go" and "give her her phone call." Wake up lady, this isn't jail! You wish it were jail!

AFter she's done peeing, the officer tries to get her out of the bathroom. She is once again fighting, flailing, screaming... and she breaks the bathroom door. Finally with the assistance of another officer, they get her out of the bathroom (while she is not wearing any pants, remember) and she is screaming "I didn't even get to go number 2!!!!" Other patients are coming out of their rooms at this point to see what's going on..... *sigh*

They finally get her over on the stretcher to get her blood kit... she proceeds to hurl herself off of the stretcher onto the floor. So, our lucky staff gets to pick her up and put her back on the bed, this time in 4 point restraints. I bet she wished she had gone to jail now - she just bought herself a long night tied down on a hard stretcher!! She is pinching people even though she is restrained, screaming about how she is goign to sue the hospital, the police department.....

As they are trying to get her settled, the secretary comes over, because at this point most of the staff is trying to assist, watching, etc..... anyway, she comes over to tell us there is a respiratory alert going on. That is our version of code. We don't call a code team because, well, we are the code team. They only call respiratory alert so the respiratory therapist can come down w/ the ventilator and the chaplain can come to be with the family.

we all leave the drunk mess, grab code carts, meds, miscellaneous equipment and see that the alert is for a patient who has already coded twice. after we get him stabilized, the charge nurse and me (neither of us are the primary nurse for this patient) are left to hang the 3rd, 4th and 5th units of blood, start the drips, clean up the mess that is the room after 3 codes.... it was like a 2 nurses to 1 patient ratio there... the monitoring was so intense we couldn't even leave the room!

and then just like that, it was 7am, and another wild night in the ER came to a close..... not minding being off tonight!!!

He? She? and PCP Pneumonia

2009-06-30T13:22:00.001-07:00

Got a patient last night in my room, saw on the tracker board it was a 29 y/o M c/o SOB x 10 days. Go into the room to see the patient and was caught off guard. Sitting on the bed was someone wearing a ton of eye makeup, a bra and the skinniest jeans I'd ever seen.

I compose myself (hopefully without making my surprise too obvious) and complete my assessment. He? she? is really coughing and lung sounds bilaterally are really coarse. I go ahead and decide to order a chest xray....

Tricky thing is, you can't be wearing a bra for a chest xray. Now, there I am, trying to figure out how to politely ask this dude to take off his bra for xray. I say "I'm going to order an xray, I'll need you to take off everything from the waist up and put on the hospital gown."

I didn't go ahead with any labs b/c sometimes the xray is definitive enough. The xray report comes back to the physician, who calls me over and says "Guess what our patient has?" Turns out our patient has a really bad case of pneumonia, called PCP, that only shows up in patients who are severely immunocompromised (i.e. HIV). This patient denied any previous medical history but in actuality has HIV with advanced complications.

Really sad for him.... Not to worry, I was cheered up by another patient who was prancing around wearing gold lace-up-the-leg sandals that looked like she was fresh out of Gladiator. We all got a good laugh about that.

Back to work tonight, ready to be off tomorrow night! This house is a mess!!!

............

2009-06-24T05:55:00.000-07:00

So... I wish my patient's heart rate had been less than 200 at some point in the evening...kind of hard to be an ICU nurse w/ 6 patients! Kind of sucks when you have to be 1:1 with a patient for so long. Also kind of sucks when that patient pulls 4 IV's out and has a BP of 70/38 and then vomits during an EJ attempt and aspirates and then needs a central line. Also I'm pretty sure I'm wearing some of that vomit on the bottom of my shoes, which sucks.

Tweety aint gonna tweet for awhile..

2009-06-21T15:53:00.000-07:00

**Definitely editing this story to preserve the minds of my audience**

So, you probably shouldn't call the ambulance when sex doesn't quite turn out the way you two (or three?) thought it was going to go. You really shouldn't be butt naked when EMS arrives, and they really shouldn't have to insist that you take a shower prior to transport.

You also probably shouldn't tell every gory sexual detail of your romantic encounter with your boyfriend sitting there, looking like a kid who got caught in the cookie jar. Don't need a visual, thanks. You should probably be getting some help for your weird and freaky self and be consoling your boyfriend after he had to get stitches... and you really shouldn't tease in front of the nurse that his "tweety aint gonna tweet for awhile."

off tonight, and very ready for a break.

You have to pay me...

2009-06-18T18:40:00.000-07:00

to go to the ER. I would NEVER choose to come sit 8 hours, get naked under a paper-thin gown and have people poke, prod and look at me in order to score a Percocet prescription. The power of addiction must be unbelievable.

Our frequent flyers have been getting creative. They have started calling up, pretending to be doctors sending patients to us, and ask what doctors are available to speak with. This is their way of finding out if their favorite doctor (the one who will prescribe narcotics) is there. If the secretary says no, they hang up before she can even transfer the call to the charge nurse.

In other news, last night I had some really sad patients that made me feel very lucky. I am so blessed w/ my health, my life, my family. I guess you really don't know what you've got 'til it's gone. I like to think that last night I made a difference in the quality of life for a very nice guy who made some bad choices and ended up a quadriplegic., even if that difference was only for a few hours. I hope I made him feel like a human being and not like a patient.

On the other hand, I did have a 94 y/o patient who screamed my name for about 8 hours, demanding I put a bedpan under her every 15 minutes. Each time I did, she'd pee about 3 tbsp. Eventually I put a foley in and got the doc to write for some Ambien and Ativan.

Working 8 hours OT tonight, having another party... oh yes, we love food on night shift. :)

You know you work in a city hospital when

2009-06-06T03:08:00.001-07:00

your drunk "John Does" are registered and show up on the tracker board as "Juan Does."

Oh, gangrene...

2009-06-03T23:43:00.000-07:00

First thing I smell when I come back from lunch. How, I wonder, can a person not notice that horrible smell following her everywhere she goes? Why did she have to be my patient? Why does she have to be a dialysis patient, limiting IV access options to one poor fat arm?

Had the nicest drunk patient, too bad he was all bloody and busted up from a fall onto the concrete when he decided to hug me. I was surprised that he was happy - I had turned down his request for 4 (yes, 4) bus tokens.

Reminded again last night that patients can turn on you in an instant. I was talking to my patient, an African-american female, mid 30's, who came in for vag bleed. Usually this is not an acute emergency. Upon her arrival, it was not. I went back in to check on her and found her literally sitting in a pool of blood that was running off the stretcher, asking for help. Within a minute or so, she went from talking to me to unconsciousness and seizures. Her mouth and tongue were absolutely white, she had lost so much blood. With a little help from GYN residents we got her stabilized, transfused and up to ICU. Thank God we had ICU beds because otherwise that would have been a long night!

Off tonight, baking cakes for work tomorrow. No special occasion, night shift just likes to have random parties.

Back in the saddle...

2009-05-28T21:21:00.000-07:00

not sure if I'm glad to be back, jury is still out! Wish I were back on the beach, but don't want to get another sunburn like the one I have now!

Went back on Tuesday night after being off for just about 2 weeks. First night back, I worked in the seniors sections, a special section for non-critical patients >65. Ambo after ambo after ambo.... we were like a revolving door for nursing home drop-offs. This is my favorite EMS call: low pulse ox reading. When EMS arrives, they put some oxygen on the patient, and *poof* the number comes up! That oxygen is magic stuff! I bet the nursing homes wish they had some lying around.....

Last night had the psych rooms. Didn't have any diagnosed crazies but sure had some wacked out people. This lady introduced herself to me as "the physician's wife." As if that was going to get her some kind of special treatment. Her husband doesn't even practice at our hospital. When her husband (the good doctor) arrived, he introduced himself as Dr. ---- = what a tool!!

Another lady wasn't my patient but she is a FF (frequent flyer) that I've taken care of before. I warned one of the newbies about her. This lady comes in like once a month for drug overdose and drinking binges. She is a compulsive pee-er and for some reason won't tie the back of her hospital gown. She likes to walk w/ her behind all out to the bathroom, then she stands there and goes basically catatonic and says she can't pee. This is lots of fun when she hits the call light every 5 minutes for you to unhook her from her heart monitor to go.

In other news, I have a not-so-secret and equally creepy admirer. I had a patient the other day from one of the local rehab facilities who left his glasses when he was discharged. I called the facility and told them I would put them in bag, label them and leave them at the front desk. The guy, maybe a nurse, not sure, starts flirting and asking me if I would drop them off when I got off from work. When I didn't acknowledge his question, he asked me when I'd be back to work and what hours I worked. I told him it varied week by week. He shows up last night and asks for me, tells the security guard I have something for him. The security guard came back and found me. I gave him the glasses and told him to tell this weirdo that I wasn't here but that he found the glasses. Bizarre.

Pet peeve of the week: (this is going to sound horrible, no real nice way to say it) Family members who are in denial about their loved one's prognosis. Now, I can see if the person is young or if they have a sudden out-of-the-blue diagnosis. That's not what I'm talking about. I'm talking about people who can't accept the fact that their 90 something year-old parent is dying. If you are a 95 year old cancer patient who stares off into space and refuses to eat/drink, I think it's time for the family to opt for no life-saving measures. I had that patient this week, and her family wanted everything done for her in the event that she coded. Seeing as how I could physically count all of her ribs and that her clavicle stood up about 1" off her chest because she was so frail and that I had to use a infant BP cuff on her b/c she was so tiny, I was SO glad she hung in there one more night. I did not want to do chest compressions....no worse feeling than ribs cracking.

Favorite interactions I heard yesterday (really really busy night):

#1
Patient's son: I have been waiting 5 hours to see the doctor. I see them just sitting around doing nothing.
Nurse: I understand that you've been waiting a long time, but we're very busy and the patients are seen in order of priority.
Patient's son: My mom is really sick, she hasn't been able to swallow for 8 days.
Nurse: Well what has she done for the last 8 days?
Patient's son: All I'm saying, my mom is a priority. She's 77 years old.
Nurse: Look, you do NOT want to be the #1 priority here. That means you are dead or dying and we are trying to save your life, and that is not a position to envy. Now go back and sit with your mother and wait your turn.

#2
Patient rang the call bell to ask the nurse if it was raining outside.

:)

Oh yes, I'm back in the saddle again......

More letters

2009-05-15T21:30:00.001-07:00

to add to my resume today! I am officially certified to provide advanced life support to neonates, infants and children.

I guess today I was thinking about how much responsibility we truly have. Nursing isn't one of those careers where you just have to pass the classes.... we are actually responsible for the information we learned. I keep adding more and more information to remember, and sometimes it's a little overwhelming. It is such a difficult profession.

We have to be intelligent, professional, have good rapport with doctors and other medical staff, and find time to hold our patient's hands and explain everything to them. We are supposed to monitor our patients constantly, no matter how many patients we have or how sick they are. We are supposed to do so during our marathon 12-16 hour shifts, often w/ a 20 minute lunch break and no potty breaks. I think ED nurses have it particularly tough. We have to stay sharp on neuro, cardiac, respiratory, GI, GU, ortho, ob/gyn, psych, and pediatrics, and be prepared to act in a moment's notice in an emergency of any of the above specialties. We are our own IV team and respiratory therapists. We must know what safe doses for meds are and be prepared to administer them immediately, keep up w/ docs... (I'm pretty sure she can't swallow that pill you just ordered - she's on a ventilator). We don't get to wait to accept patients until shift change. Combine that w/ overcrowded waiting rooms, lack of resources and funding, staffing issues, ED boarders, drug seekers and unrealistic expectations of patients(I'm sorry, I don't have time to sit here and spoon-feed your mom; we don't have pillows; we don't know how long it will take to find a bed upstairs...), it's a miracle that people are still going into nursing!!!

And it's a miracle that despite it all, I love my job! However, I am SO excited to be away from it for 10 days. I need a little mental and physical break!

Be back in 2 weeks!

Life lessons

2009-05-13T05:49:00.000-07:00

Don't fall asleep on your toilet while smoking a cigarette. You may end up with 3rd degree burns of your face, neck and chest.

Death ain't pretty, folks....

2009-05-09T00:16:00.000-07:00

I have had the unfortunate experience of coding several very sad cases recently.... see a previous post of a guy who died on his birthday. I had a patient who had only been in this country for 2 days, visiting his family, broke out in seizures w/o any history of seizures, and came in unresponsive. Another guy, 52 y/o, dropped dead while playing basketball w/ his kid.... the list goes on and on.

All of these in 1 night.

Death ain't pretty. It's downright ugly. When the 1st person who started CPR was actually compressing the stomach and we are suctioning vomit out of the airway, when the downtime is unknown and the patient is gray upon arrival, when the 3 year old child comes in w/ fixed and dilated pupils, when there is blood coming out of the eyes, ears,nose, mouth, etc..., it isn't pretty. When your back is hurting b/c you've been doing chest compressions on and off for hours on 4 different patients. When we put a body bag on the code bed under the sheet, just in case. When you have to interrupt the family to move the body to another room because you have another priority 1 on the way. When there are tubes coming out of the patient's mouth, chest, bladder, arteries/veins and needles, paper, plastic, syringes, open med vials, bloody sheets and trash everywhere while everybody is standing around waiting for the doc to call TOD on a 30 y/o pt who we have coded for over an hour w/o return of heartbeat.

It isn't pretty. I know that a lot of floor nurses hate when ER sends patients up w/ their 9pm Nexium dose not given, or the patient not totally undressed, or w/o their 2100 antibiotic started. Please understand, we are not minimizing the work you do upstairs. but PLEASE understand what we are dealing with. Please understand that it is so hard to walk out of that 30 year old's room where family is hysterical and try to catch up on an hour's worth of code charting. Please understand that is hard to walk into the next room right away and pretend that you have not been involved in a tragedy. Please understand why I am not rushing to get the medication reconciliation done. I wish some of these frequent flier not-sick patients could stand in on a code and watch what a true emergency is. I wish some floor nurses could see what I was doing instead of giving the antibiotic.

No matter how hard you try or how much you clean up the room.... it ain't pretty.

And exactly how did you find this out?

2009-05-08T23:00:00.000-07:00

I am stealing some stories from a friend, since I have been off for several days. Can't keep all my eager readers waiting.... ;)

True Story #1

Nurse: Do you have any allergies to medicines?
Patient: Chloroform.
Nurse: Chloroform? Are you sure?
Patient: Maybe it's chlorophyll.
Nurse: uh......., so no allergies?

True Story #2
Nurse: What brings you to the hospital today?
Patient: I think I got food poisoning from this hot dog *pulls hot dog (in bun) out of purse*. Can you test the hot dog for ecoli and bacteria?
Nurse: We don't test food. Our labs test samples from people.
Patient: Oh, nevermind. *Turns to friend* Let's get out of here. *sets hot dog down on the floor next to the stretcher.
Nurse (in her mind): Be my guest.
**Patient and idiot friend leave. Fast-forward 35 minutes, patient reappears. **
Patient: Can I have the hot dog back?

:)

It's true....

2009-05-04T06:39:00.000-07:00

Your nurses laugh at you.

Here is a list of people we have laughed at recently. One of our peds docs has started a list of stupidity.

- My child doesn't want to go to school.
- I had diarrhea 2 (almost 3 times).
- I got into a car accident yesterday and my son is scared because of it.
- My shoes are too small and my feet hurt on both sides in the same part.
- Fever of 111 for 6 days, then admits they don't have a thermometer.
- Child is sighing
- "I want to know how much I weigh."
- I ALMOST got into a car accident (my personal favorite).

I made a photocopy of the list at work last night but forgot it.. I will bring it home tonight and update more. This is a great list.

In the meantime, I got to do some actual nursing tonight. Had a really sick guy come in today, on his birthday of all days, in resp. distress who progressively deteriorated despite our interventions and coded. We were about to start transcutaneously pacing him, already had him in Dopamine and Tidril drips, mixing up Levophed when the family came back. Patient had been all over the place w/ vitals, heart rhythms, etc... until when his wife came back and held his hand. At that time, his BP dropped to 46/32 and he went asystolic on the monitor. I was really glad that the wife told us not to do CPR at that point. As disturbing as the sight of their loved one in that state would be (and the state of the room), sometimes I think it's good for them to come back and see that we really did all we could for their loved one. Personally I think it helps give closure.

Pet peeve of the night: patients that are seen in the ED and then referred to a neurologist or surgeon or GI doc at discharge, then don't follow up and keep coming back to the ED for the same problem. How many times do I have to tell patients w/ colicky gall bladder disease that IT WON'T GO AWAY UNTIL THE GALL BLADDER IS OUT?!?!?!! That is why you need to call a surgeon.

Anyway, it's nurse's week this week, and one of the docs said he might take us all out for breakfast tomorrow... that would be fun! Hopefully we'll get a good crew at work tonight who will be up for it!

Have you ever heard

2009-05-01T06:00:00.000-07:00

the saying "that's when the crap hit the fan?" well, last night, we found out what that would literally look like. Psych patient out of control, everybody in the acute side could hear him screaming and hollering. Right at shift change, he decides he's going to take his colostomy bag and fling liquid poop all over the place. When I say all over the place, I mean all over the walls, ceiling, staff members AND another patient. It was absolutely ridiculous. The poor other patient, just a 17 year old girl, had to then be hosed down basically in the shower. They had to take down ceiling tiles and replace them. The tech had to wash the poop out of her hair. Talk about nasty.

Had a couple of actual sick people... Sent an acute MI patient to the cath lab. Did pretty well with time - goal is to be inflating first balloon within 90 minutes of arrival, we got ours in 73 minutes. Not bad considering he had no IV access and the doc had to put in a subclavian line. He had a 100% blockage of the RCA. Had a guy that kept going into SVT... Another guy that started out as a GI bleed tele pt that ended up being an ICU admit for severe hypotension, runs of v-tach... had him on like 4 drips. Of course they "found" an ICU bed for him @ 0730, when I had already had the patient for 12 hours and was going home.

So tired of swine flu.... I told a patient tonight that he could not have a mask. Last time I checked, asthma is not contagious. Everybody and their brother is walking around the ER w/ a mask on looking ridiculous. Stop wearing it, we are all laughing at you!

Pet peeve of tonight: We cannot give you any advice about swine flu or what you should/shouldn't do with your child over the phone. I can't tell you to bring them in, keep them home, send them to school, etc.... DON'T CALL US! I believe all of that falls under the category of "parenting."

Off tonight, thank God.. need a break.

Did I miss the memo?

2009-04-27T10:39:00.001-07:00

Was Saturday night "bring your child to the hospital night?" I have never seen the waiting room so full of kids. When I looked on the tracker board, there were like 20 kids in the waiting room alone and our 9 bed pediatric section was filled to the max. I was working triage/assessment, and I usually just do the adults and there is a nurse practitioner who does the kids. Well, at about 1:30am, there was a line all the way to the back of the waiting room so I decided to jump in and help her triage some of these kids. At one point, one of the peds nurses went outside and made an announcement that the wait time to see the doctor was about 4 hours.

To all parents:

Please do not bring your child to the ER:
-they threw up one time at midnight
-they have had a fever on and off for a few days w/ no other symptoms
-they have a boil on their leg
-they have a rash on their arm

Please do not bring your child in and then let them run around the peds section playing. This usually makes me think that they aren't sick.

Please do not show up empty handed and expect me to feed your entire family, and provide you with diapers, wipes, formula etc.

Please especially do NOT do any of the above at 3am, we are busy enough with actually sick people.

That way, we can have empty rooms for the 2 pediatric codes, the status epilepticus kid and the suspected swine flu kid.

Thanks.

Did you know....

2009-04-25T11:32:00.000-07:00

that the KKK operates by implanting devices in people's spinal cords? Their victims have no recollection of the implantation but have various side effects and injuries from said devices: dry skin, cuts on the hands, hair loss, missing teeth, etc. Apparently the only way to counteract these monitoring devices is to buy a magnet, wrap it up in some pantyhose and dangle it down your back. They also appoint a special operator to monitor you and send you messages through the media that are received through your spinal cord. One of these messages is to smother your sister with a pillow.

Or at least, that what my patient told me. Apparently she was one such "victim."

Ali, this is for you...

2009-04-23T16:07:00.000-07:00

Since I haven't worked in a few days, I don't have new stories to post. At the request of my sister I will post some older stories for your enjoyment.

30 something y/o M, drives himself to the ER after being see at an urgent care center. Usual stuff is getting done - IV, labs, fluids, etc. Suddenly he starts flipping out, screaming and peeing on the walls. Promptly he is transferred to one of the psych evaluation rooms. Fast forward to 7p, when I come to work. I am getting report from the previous nurse, and when I go to see the patient, I notice that his lips are black and kind of shredded. Yes, he had been chewing on his own lips. The patient was in restraints and had a cast on one arm (why they didn't restrain that arm I dont know - makes sense to not have him swinging a cast around). I go to the doc and say, this guy needs some Ativan b/c he is out of control. Now for you non-medical people, it usually takes anywhere from 2-6mg to Ativan to really start chilling people out, especially since it was given IV. 18mg later, the man is still flailing around in the bed.

I guess it all hit the fan when I went in to recheck him. I guess he had lost the taste for his lips and decided his IV looked tasty. Yep, he bit it out of his arm. Fortunately he did not swallow it! We then decide to do a "social intubation" which is basically a nice way of saying, this dude is crazy and he needs to be knocked out. However, he needed to have at least 1 functioning IV prior to this happening. You can imagine that was not easy.

Our charge nurse came in to help, and a random PA from the ICU was walking by. She jumped in and said, "I'll put a femoral in!" So, there are about 5 of us, holding this guy down while the charge nurse is laying on top of the patient. The ICU PA has laid the sterile drape over the charge nurse's back. Unfortunately for her, the patient was farting up a storm. Some helping hand came behind us and pulled curtain shut - from the outside I'm sure it looked shady.

It took so much sedation, but we finally had him out. Whew, thank God!

Did I mention that during this whole fiasco, the lady in the next room is calling out to me for a meal tray? Lady, can't you hear that we're a little busy????

:)

Stranger than fiction

2009-04-22T13:15:00.000-07:00

Apparently, "stranger than fiction" has become the story of my life. At least my work life. I have decided that some of these encounters and actual stories at work must be documented for the public to know and fully appreciate the ER staff.

These are our stories....

Day 3 of my orientation in this ER. In the code rooms w/ my preceptor, taking care of mostly not-sick people and one gentleman that had a recent stroke. Past the 3 hour window for TPA, but definitely needed monitoring. All day he kept asking if he could just go outside and smoke, to which I kept telling him "no."

When I came out of another patient's room, a family member approaches me and states that this guy is starting to get agitated. I see the NP who wrote his admission orders and walk over to ask for some Ativan or something to try to chill this guy out. As I am walking over, another family member runs out and says "He's ripping everything off." I hurry into the room and sure enough, there is an IV, still attached to tubing, dripping on the floor, monitor leads ripped off, alarms going off. Where is the patient?

He is standing right in front of the ambo bay, still inside the hospital. I come up to him and tell him he needs to go back to his room. He then proceeds to put his hands around my neck and tries to choke me.

Lucky for me and my airway, some EMT's were coming in and saw my predicament. As the automatic doors opened to let the EMT's in, the patient proceeded to let go of my neck, and run outside and grab the EMT's neck. Somebody saw this all going down and called security, who finally arrived and took the patient down to the ground.

All in a day's work.

_____________________________________________________________

So for some reason all drunks must come to our hospital, lay on our stretchers and vomit/urinate all over themsevles all night while yelling obscenities at visitors, patients and staff. My favorite is a newcomer, let's call him Steve, who slept for about 8 hours in front of the nurses station. Steve decided that he was done sleeping, and he wanted to leave. What did he want first? Someone to help him change his diaper. Fair enough, right? wrong. Steve decided that the best way to achieve this goal was to shuffle around the ER with his dirty diaper hanging off his butt and his pants around his ankles, asking anyone and everyone to help him and of course, for the obligatory bus token. Some poor soul took pity on Steve and helped into the bathroom. What did Steve do? Steve left his dirty diaper and poop-covered socks in the middle of the bathroom and closed the door behind him when he left. Nobody realized it until some unsuspecting patient approached us with a look of horror and told us the bathroom was "dirty." Steve proceeded then to come back and visit us 3 more times in 24 hours, each time leaving with, you guessed it, a bus token.

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26 y/o F presents w/ vag bleeding x 2 months. What is her actual chief complaint? Tampon stuck. Lucky me, she comes back to my room. Dr and I get her set up for a pelvic to a) examine the bleeding and b) remove said tampon. To our surprise, upon exam there was no bleeding, and what she claimed to be a tampon were 2 round, flat white absorbent pads that looked like nipple pads used by breastfeeding mothers. I would have asked her what they were, but, like most of my patients that night, she only spoke Spanish. In this case it was probably a blessing because I probably did not want to know what that was.

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23 y/o F, nursing student, cc: vag bleeding x 4 months. Sts she is bleeding so heavy that it is overflowing and that she has changed her pad 11 times during her 5 hours in the waiting room. My first question? Why did you wait 4 months to get it checked out? Her answer: I go to school M-F. Me: no spring break, no days off, etc, to get it checked out? Her: no answer. Nonetheless, I go ahead with the usual, labs, fluids, sono, pelvic.

As she is getting ready to be discharged (after I explained to her about 10 times that the ovarian cyst that was an incidental finding on her sono was NOT cancer), I notice that all the supply drawers are open in the room and I see her purse overflowing with the pads that we use at this hospital. Whatever, I think; I'm not going to make a huge deal. Then, she has the nerve to ask me for more pads. I look at her and say "I see that you have already taken an entire pack and stuffed them in your purse, so NO, I don't have any more for you."

More to come!