The hospital where I work just became smoke free. No smoking in the hospital, around the hospital, under the hospital, above the hospital. All space occupied by the hospital, all property owned by the hospital, no cigarettes allowed. While some may rejoice in seeing the dingy little hovels where the clear paned glass had turned a lovely nicotine brown removed from the hospital premises, those who looked to them as a haven from hospital woes aren't as thrilled. But seriously, if you are a health care worker and you smoke, well, this little order won't stop you. Think about it, not only are you bombarded with education (we practically throw "quit smoking today!" packets at every patient that walks in the door) but you've also withstood seeing firsthand evidence of what smoking can do to you in the patients you care for. So, where there's a will there's a way, and I stumbled across the way this morning. Across the street from the hospital, there is a little grove of trees that screen you from the all seeing eyes of the hospital's many windows. And behind these scrawny little trees is a make-shift garbage bag ash tray with several hospital employees furtively inhaling and exhaling as quickly as possible before their shift begins. I catch an eye and the look is of sheer desperation, a silent plea to not report this misdemeanor. I won't, but maybe someday when they're my patient, I'll make sure they're educated on the perils of smoking. Because they must not know.
Monday, April 28, 2008
Friday, March 21, 2008
End Game
We stare at each other, gridlocked.
"Please let go, I don't want you to hurt yourself." I plead.
"Well, then stop hurting me." she retorts. I'm slowly prying her fingers one by one off of the arterial line. I look at all the tubes we have her hooked up to, the oxygen mask, her incisions. If I didn't know I was in the hospital, I guess I'd think everyone here was trying to hurt me too. As I'm filling with sympathy, her hand gripping my wrist lunges at me. I instinctively jerk back, but not in time to prevent getting two long scratches down my hand. I think I see some drops of blood pooling to the surface. My 72 year old, sweet-as-could-be patient, just drew blood! I manage to loosen the last of her fingers from the A-line and without loosening my grip I tie her arm down to the bed with a restraint. The next hand quickly follows, though I stay far out of reach from those dagger like nails. Once securely fastened, I ponder this paradox. I tell her we're not trying to hurt her, and now she's tied to the bed like a criminal. I have a feeling she's not going to trust me again. I go to call the doctor and scrub some Purell on my hands. The stinging I feel reminds me of the battle just fought. Well, score one for the 72 year old, I think.
___________________________________________________________________
Update: This patient was suffering from delirium, which is pretty common in older patients in the hospital, especially when medications and lack of sleep are involved. She is now doing fine but remembers our little adventure, and thankfully no longer thinks I'm trying to kill her.
"Please let go, I don't want you to hurt yourself." I plead.
"Well, then stop hurting me." she retorts. I'm slowly prying her fingers one by one off of the arterial line. I look at all the tubes we have her hooked up to, the oxygen mask, her incisions. If I didn't know I was in the hospital, I guess I'd think everyone here was trying to hurt me too. As I'm filling with sympathy, her hand gripping my wrist lunges at me. I instinctively jerk back, but not in time to prevent getting two long scratches down my hand. I think I see some drops of blood pooling to the surface. My 72 year old, sweet-as-could-be patient, just drew blood! I manage to loosen the last of her fingers from the A-line and without loosening my grip I tie her arm down to the bed with a restraint. The next hand quickly follows, though I stay far out of reach from those dagger like nails. Once securely fastened, I ponder this paradox. I tell her we're not trying to hurt her, and now she's tied to the bed like a criminal. I have a feeling she's not going to trust me again. I go to call the doctor and scrub some Purell on my hands. The stinging I feel reminds me of the battle just fought. Well, score one for the 72 year old, I think.
___________________________________________________________________
Update: This patient was suffering from delirium, which is pretty common in older patients in the hospital, especially when medications and lack of sleep are involved. She is now doing fine but remembers our little adventure, and thankfully no longer thinks I'm trying to kill her.
Saturday, March 15, 2008
When Patients Attack
"Help! Help!" My patient croaks from her freshly extubated throat.
"What's going on, what's wrong?" I ask my once perfectly sane patient.
She glares at me with all the menace she can muster.
"You know what's going on," she accuses.
"Where are we right now, {insert name here}?" I ask, wondering if this is the dreaded neuro status change.
"I know where we are right now, don't talk to me like I'm stupid."
"I don't think you're stupid {inserted name}, I just want to make sure your head is doing okay." Wrong choice of words.
"Well, that is not.... that is so rude to say my head is not okay. You are just not a very nice person. I want my lawyer. Now. And the police."
I try to smile reassuringly. "{name} you're in the hospital, you hurt your head, you don't need your lawyer."
"I don't trust you!" If looks could kill, I'd be in the morgue.
"Why don't you trust me?" I try to get a reasonable dialogue going again.
"You smile too much." She states, perturbed. I gulp down another grin.
"You can't hold me here against my will!" She starts to panic and I try to keep her from hurting herself as she becomes entangled in all the different tubes and wires we have her connected to. She grabs her arterial line in a vice like grip and I can just envision the bloody mess, not to mention dangerous blood loss, if she manages to pull that out. I grab her hand as she grabs my wrist with her other hand. For a 72 year old woman who's been laid up in a hospital bed for several days, she's surprisingly strong. And while I don't want to hurt her, I can see in her eyes she doesn't care one whit about hurting me. We are locked in place. If I pull, the A-line could go. If I let go, it's coming out anyway. Just as I'm hoping for some innocent passerby to see my predicament and help, my patient makes the first move. To be continued...
"What's going on, what's wrong?" I ask my once perfectly sane patient.
She glares at me with all the menace she can muster.
"You know what's going on," she accuses.
"Where are we right now, {insert name here}?" I ask, wondering if this is the dreaded neuro status change.
"I know where we are right now, don't talk to me like I'm stupid."
"I don't think you're stupid {inserted name}, I just want to make sure your head is doing okay." Wrong choice of words.
"Well, that is not.... that is so rude to say my head is not okay. You are just not a very nice person. I want my lawyer. Now. And the police."
I try to smile reassuringly. "{name} you're in the hospital, you hurt your head, you don't need your lawyer."
"I don't trust you!" If looks could kill, I'd be in the morgue.
"Why don't you trust me?" I try to get a reasonable dialogue going again.
"You smile too much." She states, perturbed. I gulp down another grin.
"You can't hold me here against my will!" She starts to panic and I try to keep her from hurting herself as she becomes entangled in all the different tubes and wires we have her connected to. She grabs her arterial line in a vice like grip and I can just envision the bloody mess, not to mention dangerous blood loss, if she manages to pull that out. I grab her hand as she grabs my wrist with her other hand. For a 72 year old woman who's been laid up in a hospital bed for several days, she's surprisingly strong. And while I don't want to hurt her, I can see in her eyes she doesn't care one whit about hurting me. We are locked in place. If I pull, the A-line could go. If I let go, it's coming out anyway. Just as I'm hoping for some innocent passerby to see my predicament and help, my patient makes the first move. To be continued...
Tuesday, March 04, 2008
The business of dying
I see death often where I work. Not the grim reaper with his scythe and black cape. Less fantastical, but just as traumatic, watching someone take their last breath. Here is something I wrote awhile back after just such an experience...
Rasping breaths, the unmistakable sound of death slowly becoming victor, filled the quiet calm of the room. Loved ones gathered around united for a moment in the face of a common enemy, mortality. Every face showed signs of a different struggle, bitterness, anger, sadness and grief beyond words. You could almost here everyone counting the seconds between each breath, wondering which would be his last, half hoping the struggle would just end, yet pleading for one more breath. Just one more. We're not ready to let go, not yet, please.. quiet prayers lifted up to an unseen God. It never got easier, watching a family go through death. Old, young, expected or unexpected, it was never easy. A cold tear slipped down my cheek, I let it linger. It didn't matter if I was too emotionally involved, I wanted the family to know I grieved with them. How can I not hurt with families, when I already know what they are feeling all too keenly? A breath is exhaled. We wait... It's over.
Rasping breaths, the unmistakable sound of death slowly becoming victor, filled the quiet calm of the room. Loved ones gathered around united for a moment in the face of a common enemy, mortality. Every face showed signs of a different struggle, bitterness, anger, sadness and grief beyond words. You could almost here everyone counting the seconds between each breath, wondering which would be his last, half hoping the struggle would just end, yet pleading for one more breath. Just one more. We're not ready to let go, not yet, please.. quiet prayers lifted up to an unseen God. It never got easier, watching a family go through death. Old, young, expected or unexpected, it was never easy. A cold tear slipped down my cheek, I let it linger. It didn't matter if I was too emotionally involved, I wanted the family to know I grieved with them. How can I not hurt with families, when I already know what they are feeling all too keenly? A breath is exhaled. We wait... It's over.
Friday, February 29, 2008
Mortal Combat
A great and terrible war ravaged the country. Households were being torn apart as young men turned from their parent's ideals, creating enemies between Father and Son. Much blood was shed, with a perpetual call for more. As is the way with most wars, each side believed they were in the right, that God, the true God, was on their side. They would be rewarded in the end, if anyone was left alive to receive it. Yet, those dead and dying men were not hideous, faceless, monsters the "other-side" portrayed them to be. These men were fathers, brothers, sons, loved ones, dear to many. But who would let themselves stop to think on this? It was easier to kill a faceless monster. And still the battles raged on, children becoming fatherless, bothers brother-less and the wide-eyed hopeful lovers became despondent and bitter as news eventually came that their happy ending would never unfold. Unbeknownst to the masses, in spite of man's follies, God uses these mistakes of mortal man for His infinitely good purposes.
Thursday, February 21, 2008
Bus rides and Bullets
I used to make up dreams when I was little. Shocking, isn't it? To be fair, my brothers would always have the most interesting dreams, and being the little sister, I had to try and keep pace with them. So I had to lie. Didn't I? Luckily I've outgrown that, I was only five you know. But now, whenever I have a real, legitimate dream, my WHOLE family quickly dismisses it to "Oh, look at Julia, isn't that cute, she's trying to be all imaginative and interesting again." Well people, it's time to put a stop to that! Especially because I do have the weirdest, vividest dreams ever, and it's a shame they're wasted on an audience of one. So, here's one I dredged up from the memory banks.
I'm waiting at a bus stop. I'm always waiting at bus stops in reality, so in dream-land it's rather predictable. It's a busy part of the day, lots of people milling around. I recognize a co-worker and wave hi. We board the bus together. A man, without a face, as dreams often go, boards behind us, and quickly pulls out a gun. I'm always the peacemaker in my dreams, I try to talk him out of whatever he's going to do. I even manage to share the gospel with him. It's all fairly tense. Then he fires and hits my co-worker. Now I go into "nurse mode." I start holding pressure and scream to the bus driver to head for the hospital. The faceless shooter disappears. Justice is not the focus of this dream. I continue holding pressure, but there's a lot of blood. I can feel it, warm and dark. It pulsates out of the wound, I'm sure it hit an artery. My co-worker is still talking to me, and I realize I don't know much about her, where her family is, who her family is. We just work together and we're pleasantly polite, it's never gone much deeper than that. I get personable now, because of course it's perfect timing, with my hands steeped in her blood. She has a daughter, and a grand baby. Now it will be much harder if she dies. We're at the hospital and I'm riding on top of a gurney with her, still holding pressure. Dream travel, I suppose. They tell me to keep holding pressure until they can get to the OR. Her daughter shows up with the baby, they're able to say goodbye. We're in the OR and I'm wearing scrubs and those weird seafoam-green surgical caps. They tell me I can let go now. I lift my hands up and all I can see is a bullet wound that's almost half healed over. I'm ushered out of the OR and the swinging doors close behind me. I know everything is going to be okay now. But my hands are still red and sticky, the adrenaline of the moment still pulsating through my arteries. I wake up with that same feeling. When I see my co-worker later that day, I tell her I saved her life. In my weird messed up dreams. Oddly, it's brought us closer... maybe someday she'll truly be saved, I only hope it won't involve bus rides and bullets.
I'm waiting at a bus stop. I'm always waiting at bus stops in reality, so in dream-land it's rather predictable. It's a busy part of the day, lots of people milling around. I recognize a co-worker and wave hi. We board the bus together. A man, without a face, as dreams often go, boards behind us, and quickly pulls out a gun. I'm always the peacemaker in my dreams, I try to talk him out of whatever he's going to do. I even manage to share the gospel with him. It's all fairly tense. Then he fires and hits my co-worker. Now I go into "nurse mode." I start holding pressure and scream to the bus driver to head for the hospital. The faceless shooter disappears. Justice is not the focus of this dream. I continue holding pressure, but there's a lot of blood. I can feel it, warm and dark. It pulsates out of the wound, I'm sure it hit an artery. My co-worker is still talking to me, and I realize I don't know much about her, where her family is, who her family is. We just work together and we're pleasantly polite, it's never gone much deeper than that. I get personable now, because of course it's perfect timing, with my hands steeped in her blood. She has a daughter, and a grand baby. Now it will be much harder if she dies. We're at the hospital and I'm riding on top of a gurney with her, still holding pressure. Dream travel, I suppose. They tell me to keep holding pressure until they can get to the OR. Her daughter shows up with the baby, they're able to say goodbye. We're in the OR and I'm wearing scrubs and those weird seafoam-green surgical caps. They tell me I can let go now. I lift my hands up and all I can see is a bullet wound that's almost half healed over. I'm ushered out of the OR and the swinging doors close behind me. I know everything is going to be okay now. But my hands are still red and sticky, the adrenaline of the moment still pulsating through my arteries. I wake up with that same feeling. When I see my co-worker later that day, I tell her I saved her life. In my weird messed up dreams. Oddly, it's brought us closer... maybe someday she'll truly be saved, I only hope it won't involve bus rides and bullets.
Thursday, September 13, 2007
Headaches and brain tumors
I have a headache. I've had a headache for the past three days. It's not debilitating, it doesn't interfere with my day to day life in any way other than being annoying. But being a nurse in Neuroland makes me suspicious. "It started with a headache," my patients always say. They ignored it. Until their faces started twitching.
Should I ignore this headache? My sane voice in my head tells me I should, I'm overreacting. But maybe my sane voice is being affected by my headache? Maybe it's really my insane voice that I'm hearing, but is usually repressed because I didn't have a brain tumor...er...a headache before.
Now I know I'm overreacting. It's just voices I'm hearing in my head. Little tiny voices convincing me it's all in my head. Well, that's kinda the point, isn't it? It is all in my head. I think I'll go take some Tylenol.
Friday, September 07, 2007
The Pose
I was a model for a day today. It's not as easy as it looks. Don't smile. Smile. Part your lips. Keep your lips closed. Turn your shoulders towards me. Look more relaxed. Look less happy. The photographer quirks his eyebrows and smirks every time he looks at your digital photo. I inwardly cringe. What does that mean? Is his lighting bad? Or do I look like a hideous ogre and he's asking himself who let this person in?
It's amazing how quickly all of your image issues come glaringly to the surface. My nose is to big, my chin is too fat, my eyes are too wide, my mouth is too small. Is that a blemish? Not to mention over-the-top makeup and hair. You stop feeling like you and start feeling like a specimen. Under a mega-watt glare of light, I sit, I attempt to look serious but not sad, happy but not joyful. Sweat is breaking out on the photographer's head. He perches on a ladder, now he crouches on the floor, now the lens is directly in my face. It holds my gaze and dilates and constricts like some giant eyeball. Now I know how bugs feel.
I try and make jokes between shots and poses because that's what I do when I'm uncomfortable. I think I'm incredibly amusing. All I get is a pained smile for my efforts. I'm not acting very professional. I curb my tongue and work on my relaxed but not slouchy pose. I won't be changing careers any time soon.
It's amazing how quickly all of your image issues come glaringly to the surface. My nose is to big, my chin is too fat, my eyes are too wide, my mouth is too small. Is that a blemish? Not to mention over-the-top makeup and hair. You stop feeling like you and start feeling like a specimen. Under a mega-watt glare of light, I sit, I attempt to look serious but not sad, happy but not joyful. Sweat is breaking out on the photographer's head. He perches on a ladder, now he crouches on the floor, now the lens is directly in my face. It holds my gaze and dilates and constricts like some giant eyeball. Now I know how bugs feel.
I try and make jokes between shots and poses because that's what I do when I'm uncomfortable. I think I'm incredibly amusing. All I get is a pained smile for my efforts. I'm not acting very professional. I curb my tongue and work on my relaxed but not slouchy pose. I won't be changing careers any time soon.
Thursday, July 19, 2007
Sunny Summer with no Snow in Sight!

The giraffe stared at us benignly as we drove by, gawking tourists with flashing boxes. You can almost see it smirk, thinking "crazy short-necks." Nevertheless, it was quite exciting to be on an African Safari in the middle of San Diego California.
Here we are taking a much needed break after a long day walking through "Africa"
Our names written in the sand
The last time you'll see my pirate headband..sigh...a roller coaster snatched it away
Our signature pose when you don't have a photographer with you, thank goodness for long arms!
I forgot that with my new computer I could actually post pictures. Which means I don't have to write as imaginatively anymore, because pictures are worth a thousand words, right? I thought I'd add some sunny perspectives since my last post was about snow. I love summer!
Wednesday, April 11, 2007
SNOW!!!!!!
This post is not for creative writing/juice flowing purposes. It is simply to yell at the world: I HATE SNOW IN APRIL!!
There, it's out. But I don't feel much better. This morning I woke up and the wind was howling. I rummaged out my winter coat that I had gleefully put away. I trudged through the bitterness to the bustop. I heaved huge sighs of woe all day at work because every time I looked out the window all I could see was white and wind. It was very depressing. We all felt it. Even our patients. All in all it was a very sad day, and now I'm going to go crawl under my warm covers and dream about a real April with showers and flowers rather than snow.. and.... dead flowers.
There, it's out. But I don't feel much better. This morning I woke up and the wind was howling. I rummaged out my winter coat that I had gleefully put away. I trudged through the bitterness to the bustop. I heaved huge sighs of woe all day at work because every time I looked out the window all I could see was white and wind. It was very depressing. We all felt it. Even our patients. All in all it was a very sad day, and now I'm going to go crawl under my warm covers and dream about a real April with showers and flowers rather than snow.. and.... dead flowers.
Tuesday, April 03, 2007
Why I can't Pee
Now, don't worry. There is nothing wrong with my urinary system. But my mother, and others, are having a hard time understanding why I find it difficult to use the restroom more than once in a twelve hour shift. This is like asking why a basketball player doesn't have time to eat tea and crumpets during a game. Or why a marathon runner doesn’t have time to play a game of chess during a race. It just isn't possible.
Let me try to map it out.
6:00am - Alarm goes off. Depending on how tired I feel, I may or may not hit snooze... more than once.
6:30am - I trek to the bus stop in the dark (before daylight saving. after we can see the first tint of dawn)
6:36 - My bus comes. It should be more like 6:38 because it's always late.
6:50 - I arrive at the hospital. I join the general melancholy trudge of traffic as we make our way into the building.
7:00 - I get report from the off-going shift. Depending who is giving report and if I've had any of these patients before, it can take 30-45 minutes.
7:30 - I plan my route of attack on my unsuspecting victims...I mean patients. Depending if I work on the floor or in the ICU that route can differ greatly. We'll go with the ICU today.
8:00-8:55 - I usually have two very sick patients, both intubated (breathing tube), needing neuro checks every hour. This means every hour I literally have to yell at my patient to show me two fingers, or a thumb up, or a wiggle of a toe. Level of consciousness is what we’re looking for, and often, neuro checks can take 20-30 minutes each, if sedation needs to be turned off and they're slow to respond.
Then there's full body assessment, heart, lungs, stomach, etc.
Then it’s time to get morning meds, which invariably all need to be crushed and flushed down an NG (nasogastric) tube. This also can be time consuming, as each patient has 15 meds in the morning. And IV drips. And injections. And eye drops.
Then there is the writing down of the vital signs, which is usually every hour for both patients as well. Heart rate, temperature, respiratory rate, pulse ox, blood pressure (by cuff and arterial line), intercranial pressure and cerebral perfusion pressure are the main ones. Sometimes depending what they're in for, other things are monitored.
Also, depending on what type of drips their on, or a special parameter the doctors want followed, I’ll have to draw blood every 4 hours or so.
The first morning hour usually flies by.
9:00am - Vital Signs and Neuro checks all over again. Sometimes more meds.
9:30am - Sign off orders, look at labs, usually something comes up that I need to call the doctors for.
10:00am - Starts again. Oh, and every even hour I have to measure how much fluid I've given the patient, and how much they've gotten rid to make sure they're not getting too much or too little. I also forgot to mention that every even hour (at the very least) we must reposition the patient to prevent bedsores. (Our unit rocks at this, by the way) Not to mention oral cares. If a patient’s mouth isn’t cleaned frequently the risk of pneumonia increases.
11:00am - Okay you say, you probably could've gone to the bathroom around 10:30ish, right? Well, I reply, you're right, I probably could. But you're assuming that everything is hunky dory. But between the hours of 10-11am is where everything, inevitably, starts going downhill.
It's called the dreaded: NEURO STATUS CHANGE.
This cascades into a series of events that always leads to a stat head CT. ALWAYS. And, just last week, it happened to both of my patients, AT THE SAME TIME. This is every nurse's worst nightmare. It's okay if just one of your patients is having issues. But both at the same time makes you want to scream. Or at least get really flushed in the face. Luckily, we work as a team in Neuro Land. One nurse takes one patient, I take the other, and we have a race downstairs.
This is called: A ROAD TRIP.
These are not the breeze blowing in your hair, sun beating on your skin, sunglass-wearing types of road trips. This is a scramble around madly, unhook a bazillion cords from the stationary monitor and plug them into the portable monitor. Call respiratory to bring their portable ventilator. Bring the IV pole with the bazillion drips and cram it all into the tiniest elevator possible (that they claimed to have enlarged for us) type of road trip. The scan itself takes approximately 2 minutes. I'm not exaggerating! But to get down there and then back up usually takes an hour. And you're just praying nothing bad has happened, that you don't have to tell the family their loved one has just gone to the OR, or they've stroked again, or any of the numerous things that could cause a neuro status change.
So it's 12:00pm now. Maybe later. Depending on what went wrong during the 10am-11am hours of doom, you're either way, way behind with no hope of a potty break until kingdom comes, or you foresee a potty break at least before the angels start trumpeting. Don't forget, you have to chart absolutely everything. "Chart like you're going to court" is a favorite saying of ours.
1:30pm (or 1330 in military time) - I usually get to go to lunch. During which, I get to use the bathroom. Technically we get half an hour, but if I want to catch my 7:36pm bus on time, I really don't want to be gone that long.
2:00pm (1400) - It all starts again.
3:00pm (1500) - And again
4:00pm (1600) - Usually the time when lots more meds pop up. And when family starts to visit. This is usually my favorite part. It does tend to take up lots of time to talk with family and explain things to them, but if I can make things any easier for them, I'll take that time.
5:00pm (1700) - The homeward stretch, usually. Sometimes it's the "Holy Guac-the-moly, I only have two hours to get all this done!"
6:00pm (1800) - The final reposition of the night. If I’m lucky there won't be any little "surprises" under the patient, but one never knows. With all the medications and tube feeding we give these poor people, we either put them into a constipation or a diarrhea mode. Never a happy medium.
7:00pm (1900) - The on-coming shift arrives. Depending on whether they've had the patients or not, report can take anywhere from 30-45 minutes. And then I’m free! Unless I have last minute charting to do, which is often the case.
7:35pm (1935) - I'm running for the bus stop. If I'm lucky, the bus is late. But the bus is never late going home, unless I'm late getting to the bus stop. At least it seems to be the case. But let’s just assume for this little literary exercise, I get to the bus on time. It's crowded with weary workers such as me, but I can usually find a seat.
8:00pm (2000) - I trek back to my apartment in the dark, even with daylight saving. I take a shower, scrubbing off the hospital scum I know to be covered in.
9:00pm (2100) - I might waste a few moments on the computer or read a little to unwind.
10:00pm (2200)- I make sure my alarm is set. I am asleep before my head hits the pillow.
Let me try to map it out.
6:00am - Alarm goes off. Depending on how tired I feel, I may or may not hit snooze... more than once.
6:30am - I trek to the bus stop in the dark (before daylight saving. after we can see the first tint of dawn)
6:36 - My bus comes. It should be more like 6:38 because it's always late.
6:50 - I arrive at the hospital. I join the general melancholy trudge of traffic as we make our way into the building.
7:00 - I get report from the off-going shift. Depending who is giving report and if I've had any of these patients before, it can take 30-45 minutes.
7:30 - I plan my route of attack on my unsuspecting victims...I mean patients. Depending if I work on the floor or in the ICU that route can differ greatly. We'll go with the ICU today.
8:00-8:55 - I usually have two very sick patients, both intubated (breathing tube), needing neuro checks every hour. This means every hour I literally have to yell at my patient to show me two fingers, or a thumb up, or a wiggle of a toe. Level of consciousness is what we’re looking for, and often, neuro checks can take 20-30 minutes each, if sedation needs to be turned off and they're slow to respond.
Then there's full body assessment, heart, lungs, stomach, etc.
Then it’s time to get morning meds, which invariably all need to be crushed and flushed down an NG (nasogastric) tube. This also can be time consuming, as each patient has 15 meds in the morning. And IV drips. And injections. And eye drops.
Then there is the writing down of the vital signs, which is usually every hour for both patients as well. Heart rate, temperature, respiratory rate, pulse ox, blood pressure (by cuff and arterial line), intercranial pressure and cerebral perfusion pressure are the main ones. Sometimes depending what they're in for, other things are monitored.
Also, depending on what type of drips their on, or a special parameter the doctors want followed, I’ll have to draw blood every 4 hours or so.
The first morning hour usually flies by.
9:00am - Vital Signs and Neuro checks all over again. Sometimes more meds.
9:30am - Sign off orders, look at labs, usually something comes up that I need to call the doctors for.
10:00am - Starts again. Oh, and every even hour I have to measure how much fluid I've given the patient, and how much they've gotten rid to make sure they're not getting too much or too little. I also forgot to mention that every even hour (at the very least) we must reposition the patient to prevent bedsores. (Our unit rocks at this, by the way) Not to mention oral cares. If a patient’s mouth isn’t cleaned frequently the risk of pneumonia increases.
11:00am - Okay you say, you probably could've gone to the bathroom around 10:30ish, right? Well, I reply, you're right, I probably could. But you're assuming that everything is hunky dory. But between the hours of 10-11am is where everything, inevitably, starts going downhill.
It's called the dreaded: NEURO STATUS CHANGE.
This cascades into a series of events that always leads to a stat head CT. ALWAYS. And, just last week, it happened to both of my patients, AT THE SAME TIME. This is every nurse's worst nightmare. It's okay if just one of your patients is having issues. But both at the same time makes you want to scream. Or at least get really flushed in the face. Luckily, we work as a team in Neuro Land. One nurse takes one patient, I take the other, and we have a race downstairs.
This is called: A ROAD TRIP.
These are not the breeze blowing in your hair, sun beating on your skin, sunglass-wearing types of road trips. This is a scramble around madly, unhook a bazillion cords from the stationary monitor and plug them into the portable monitor. Call respiratory to bring their portable ventilator. Bring the IV pole with the bazillion drips and cram it all into the tiniest elevator possible (that they claimed to have enlarged for us) type of road trip. The scan itself takes approximately 2 minutes. I'm not exaggerating! But to get down there and then back up usually takes an hour. And you're just praying nothing bad has happened, that you don't have to tell the family their loved one has just gone to the OR, or they've stroked again, or any of the numerous things that could cause a neuro status change.
So it's 12:00pm now. Maybe later. Depending on what went wrong during the 10am-11am hours of doom, you're either way, way behind with no hope of a potty break until kingdom comes, or you foresee a potty break at least before the angels start trumpeting. Don't forget, you have to chart absolutely everything. "Chart like you're going to court" is a favorite saying of ours.
1:30pm (or 1330 in military time) - I usually get to go to lunch. During which, I get to use the bathroom. Technically we get half an hour, but if I want to catch my 7:36pm bus on time, I really don't want to be gone that long.
2:00pm (1400) - It all starts again.
3:00pm (1500) - And again
4:00pm (1600) - Usually the time when lots more meds pop up. And when family starts to visit. This is usually my favorite part. It does tend to take up lots of time to talk with family and explain things to them, but if I can make things any easier for them, I'll take that time.
5:00pm (1700) - The homeward stretch, usually. Sometimes it's the "Holy Guac-the-moly, I only have two hours to get all this done!"
6:00pm (1800) - The final reposition of the night. If I’m lucky there won't be any little "surprises" under the patient, but one never knows. With all the medications and tube feeding we give these poor people, we either put them into a constipation or a diarrhea mode. Never a happy medium.
7:00pm (1900) - The on-coming shift arrives. Depending on whether they've had the patients or not, report can take anywhere from 30-45 minutes. And then I’m free! Unless I have last minute charting to do, which is often the case.
7:35pm (1935) - I'm running for the bus stop. If I'm lucky, the bus is late. But the bus is never late going home, unless I'm late getting to the bus stop. At least it seems to be the case. But let’s just assume for this little literary exercise, I get to the bus on time. It's crowded with weary workers such as me, but I can usually find a seat.
8:00pm (2000) - I trek back to my apartment in the dark, even with daylight saving. I take a shower, scrubbing off the hospital scum I know to be covered in.
9:00pm (2100) - I might waste a few moments on the computer or read a little to unwind.
10:00pm (2200)- I make sure my alarm is set. I am asleep before my head hits the pillow.
Monday, February 26, 2007
Loss
I think if I thought more about what happens at work, I'd never be able to go back. So I numb myself. I distance myself. These are the tasks I must accomplish, I must keep this person alive, I must keep them clean and comfortable, I must be pleasant and calm when inward I'm seething, I must know the whys and the what’s behind every task. I do this very well.
Yet, I had this beautiful, noble purpose about becoming a nurse. I could help families through the same struggles. I'm one of the few who can say, "I know what you're going through. Really."
But I just can't make myself that emotionally available. I can't. I thought working where I'm working would promote healing, give closure. All I've done is replace old feelings with newer ones. Horrible memories with less horrible. So there it is. And here I am. Stuck. I do my job, I do my duty, but was I able to ease the pain?
I can't even remember, except small snippets, the pain I went through, my family went through. I almost feel brainwashed. I've almost erased this huge experience. And when I try to bring back those memories I mentally cringe and can't bring myself to do it. So, I go through the motions of my day, I do my work very well, but if I ever once try to go back and put myself in their shoes I hit a wall.
Yet, I had this beautiful, noble purpose about becoming a nurse. I could help families through the same struggles. I'm one of the few who can say, "I know what you're going through. Really."
But I just can't make myself that emotionally available. I can't. I thought working where I'm working would promote healing, give closure. All I've done is replace old feelings with newer ones. Horrible memories with less horrible. So there it is. And here I am. Stuck. I do my job, I do my duty, but was I able to ease the pain?
I can't even remember, except small snippets, the pain I went through, my family went through. I almost feel brainwashed. I've almost erased this huge experience. And when I try to bring back those memories I mentally cringe and can't bring myself to do it. So, I go through the motions of my day, I do my work very well, but if I ever once try to go back and put myself in their shoes I hit a wall.
Monday, October 30, 2006
Needles
I hate needles. With a passion. The first time I went to Mongolia I had to get five different vaccinations. The last one made me pass out. Sharp pointy thing overload. I still donate blood, though the grimaces on my face makes the phlebotomist nervous. "Are you sure you’re okay?” and “Do you need some water?" and "Are you going to pass out on me?" is the final question they usually ask as I scrunch my eyes up and probably turn deathly pale. I can't help it. It's the fight or flight response in over-drive. However, I have no problem putting sharp pointy things in other people. Yet, I can definitely empathize with the look of panic that crosses my patient's face before I make the plunge into their skin.
Why all this sharp talk? Well, today I received the most beautiful TB skin test and flu vaccine ever. I was lucky number 300th poke, so this lady was a pro. I didn't feel a single thing. Usually when I get a TB skin test, I end up with a ginormous bruise on my forearm within a matter of minutes. This time... nothing. My deltoid usually aches for days on end after a flu shot. This time? Nothing! I'm as surprised as you are. I didn't even flinch. Maybe I’m conquering my fears after all. Or maybe I just need to be number 300 more often.
Why all this sharp talk? Well, today I received the most beautiful TB skin test and flu vaccine ever. I was lucky number 300th poke, so this lady was a pro. I didn't feel a single thing. Usually when I get a TB skin test, I end up with a ginormous bruise on my forearm within a matter of minutes. This time... nothing. My deltoid usually aches for days on end after a flu shot. This time? Nothing! I'm as surprised as you are. I didn't even flinch. Maybe I’m conquering my fears after all. Or maybe I just need to be number 300 more often.
Saturday, September 23, 2006
To market, to market...
I went to the farmer's market with my friend after work this morning. I love the farmer's market. It's what living in this semi-big city is all about. On every corner, you’ll see a different musician or street player, from a classical violin to bongos on a bench, trying to outplay each other, but creating a pleasant mixture of sound together. Among the noise floats the aroma of freshly baked cinnamon roles and the smell of earthy-ness from the various veggies and herbs in mouth-watering arrangements. Calls from vendors that were perfected in the days of Newsies also vie for attention. Food for the stomach: "get your warm, hot, spicy cheese bread over here, fresh from the oven!" and food for the soul: "get your peace, everlasting peace over here!"
I love this open market atmosphere and the good-natured heckling and banter you can eavesdrop on between booths. The one thing that's different in this open market than from other open markets around the world is that there are fixed prices. No haggling over how much you're going to pay for a pound of spinach. (Though you can pretty much be handed the I-swear-it's-safe-spinach free these days.) Don't get me wrong, the prices are more than reasonable, but sometimes it's fun to barter. Though I'm very much a softy, so I'm the sucker most vendors would pray for. It’s mostly just the remnants of Mongolia speaking now.
After walking around the square twice, I decided on some beef jerky, grape tomatoes, raspberries, sunflowers and these weird magenta flowers that look like coral from the ocean. I have no idea what they’re called, but I had to get them because they’re the coolest looking plants I’ve ever seen. I should also mention I got some green beans, green peppers, pears, apples and cheese curds. As you can see, I just randomly grabbed things that appealed to me. That’s my favorite type shopping, just spontaneous buys rather than an agenda. And the market is the perfect venue for that. Especially after working all night and everything begins to look blurry in the daylight. Now I’m off to eat some raspberries and cream. Well, raspberries and skim milk… but that’s almost the same… right?
I love this open market atmosphere and the good-natured heckling and banter you can eavesdrop on between booths. The one thing that's different in this open market than from other open markets around the world is that there are fixed prices. No haggling over how much you're going to pay for a pound of spinach. (Though you can pretty much be handed the I-swear-it's-safe-spinach free these days.) Don't get me wrong, the prices are more than reasonable, but sometimes it's fun to barter. Though I'm very much a softy, so I'm the sucker most vendors would pray for. It’s mostly just the remnants of Mongolia speaking now.
After walking around the square twice, I decided on some beef jerky, grape tomatoes, raspberries, sunflowers and these weird magenta flowers that look like coral from the ocean. I have no idea what they’re called, but I had to get them because they’re the coolest looking plants I’ve ever seen. I should also mention I got some green beans, green peppers, pears, apples and cheese curds. As you can see, I just randomly grabbed things that appealed to me. That’s my favorite type shopping, just spontaneous buys rather than an agenda. And the market is the perfect venue for that. Especially after working all night and everything begins to look blurry in the daylight. Now I’m off to eat some raspberries and cream. Well, raspberries and skim milk… but that’s almost the same… right?
Wednesday, September 20, 2006
Found
My journal that is. One word: yay! With my personal rantings, outpourings of angst and the odd dream or two, I'm sure if offered some interesting summer reading to the people who happened upon it. But as long as I never have to meet them, I'm totally okay with strangers reading (and most likely laughing about) my innermost thoughts. I had just resigned myself to never seeing my beloved book of candor again, and was starting afresh when my mom told me it had been discovered and was now racing its way in the mail to my house. Again: yay! Now I can write my most intense feelings into a book with a front and back cover, feel the pen flow across the page, and write about the more trivial things on my blog. Finally: yay!
Wednesday, September 06, 2006
Messed Up
I am completely messed up. Well, let me rephrase that, I am completely messed up sleep wise. But maybe I'm just completely messed up too. I wouldn't doubt it. Last night I had off from work, and usually it's no problem for me to stay awake all night and then sleep all day in order to prepare for work the next night. But last night I totally closed my eyes on the couch, knowing full well it would come to no good, and sure enough five in the morning rolls around and I wake up. Instead of prepearing for bed, like I should have been doing. So I'm messed up. Now it's one in the afternoon and I'm wide awake. Luckily I don't have to work until 11pm tonight, or 2300 in good 'ol military time. So there might be a moment or two for napping later this evening. I think I'm going to go and enjoy the sun, in the middle of the day, which is something I rarely get a chance to do. This might not be such a bad turn of affairs after all.
Thursday, August 31, 2006
Thursday, August 24, 2006
Sirens, Lights, Ticket!
Okay, before everyone starts cheering about this because, I, a well known speeder and escaper of tickets, finally got one, let me explain the inhumanity of it all. I'm not one bit repentant. Well, maybe a little. But definitely not a lot. All the other times I've been pulled over, if I HAD received a ticket, I would have nodded acceptance to my obvious guilt and taken it without a single iota of resentment. The police officers, in their graciousness, deemed me to either be
1. a learner from my mistakes
2. a nurse who should know better
3. a really sad, pathetic little girl, who needs to drive away fast before I get really annoyed with her crying
4. an offence worthy of a written warning only OR
5. to have such a good record, it would be a shame to mar it with a ticket.
Yup, I think that's all of them. But this time was different. This time I was not speeding. Technically. In my own opinion.
I was in a 55mph speed zone, I'll admit it. But I could SEE the 65mph speed sign in front of me. So I felt at liberty to increase my speed. And of course, RIGHT before I reach the 65mph sign, a police officer, just waiting for it's speeding prey, pounces like a chimpanzee on a cheeto. There was no pleasant banter, no small talk like I had grown accustomed to. It was all business. This was because he knew it was a cheap trick and wanted to get me out of there as soon as possible because he was so shamefaced. It was written in his every move. Or perhaps he just wanted to get back quickly to his same sneaky position and catch another unsuspecting bug in his venous fly trap.
I have my ticket, and I'll pay my dues, but there is no way I'll feel contrite about this one! Um...but it's made me a safer driver. And better observer for stationary squad cars.
1. a learner from my mistakes
2. a nurse who should know better
3. a really sad, pathetic little girl, who needs to drive away fast before I get really annoyed with her crying
4. an offence worthy of a written warning only OR
5. to have such a good record, it would be a shame to mar it with a ticket.
Yup, I think that's all of them. But this time was different. This time I was not speeding. Technically. In my own opinion.
I was in a 55mph speed zone, I'll admit it. But I could SEE the 65mph speed sign in front of me. So I felt at liberty to increase my speed. And of course, RIGHT before I reach the 65mph sign, a police officer, just waiting for it's speeding prey, pounces like a chimpanzee on a cheeto. There was no pleasant banter, no small talk like I had grown accustomed to. It was all business. This was because he knew it was a cheap trick and wanted to get me out of there as soon as possible because he was so shamefaced. It was written in his every move. Or perhaps he just wanted to get back quickly to his same sneaky position and catch another unsuspecting bug in his venous fly trap.
I have my ticket, and I'll pay my dues, but there is no way I'll feel contrite about this one! Um...but it's made me a safer driver. And better observer for stationary squad cars.
Wednesday, August 16, 2006
Return
I'm back from Mongolia.
I'm not sure how I feel about that.
People ask me how my time was, and say it must have been so much fun. But that's not how I would describe it. It had its fun moments, but it definitely wasn't fun. It had its exhilarating moments, but I wouldn't fully describe it that way either. There were time-to-go-back-to-America moments, and I-wish-I-could-stay-here-forever moments. Emotionally grueling moments, physically trying moments. God ordained, Holy Spirit filled moments.
I try to explain these things to my family, my friends, my co-workers. It's like trying to describe a sunset to a blind person. You can tell them about all the brilliant shades of colors, but unless you actually see it, unless you are actually there, you will never fully understand the immense experience of it all. But of course, that will never keep me from trying to use all my descriptive ability to impress upon my audience how two weeks can have such a lasting impact on life.
I'm not sure how I feel about that.
People ask me how my time was, and say it must have been so much fun. But that's not how I would describe it. It had its fun moments, but it definitely wasn't fun. It had its exhilarating moments, but I wouldn't fully describe it that way either. There were time-to-go-back-to-America moments, and I-wish-I-could-stay-here-forever moments. Emotionally grueling moments, physically trying moments. God ordained, Holy Spirit filled moments.
I try to explain these things to my family, my friends, my co-workers. It's like trying to describe a sunset to a blind person. You can tell them about all the brilliant shades of colors, but unless you actually see it, unless you are actually there, you will never fully understand the immense experience of it all. But of course, that will never keep me from trying to use all my descriptive ability to impress upon my audience how two weeks can have such a lasting impact on life.
Thursday, July 20, 2006
Theological Talks
I'm back from working my "princess shift" a four hour filler shift from 7pm to 11pm. Don't ask me why I have to work this ridiculous period of time, I just suck it up and do it. But now I have a long empty, sleepless night stretching out before me and so I thought I'd bare my soul on my blog because I don't have my journal. Yes, I know I could start a new one, but I'm still holding out hope that it will be found in the near future. Hopefully. I hope. Really, really hope. A lot. A lot of hoping. Sniff.
Last night I had a very long talk with a fellow co-worker about my Christian beliefs. It was, in fact, a three-hour conversation. (It was a slow night, what can I say?) It provided the opportunity for basically everyone in the ICU to hear about my devotion to Christ. Our debate ranged everywhere, from creation vs. evolution to the divinely inspired word of God vs. a book written by a bunch of drunk men to heaven and hell vs. ascending into another plane of existence to God's sovereignty in suffering vs. happenstance to Predestination vs. Free Will, we're talking some very heavy issues here.
The majority of instances when I have these types of conversations I am always so afraid. Afraid of what other people will think of my stance, afraid of being shunned by friends, afraid of saying the wrong thing, afraid of not knowing what to say. Last night I was bold in my conversation, I was always able to answer his questions (not to his satisfaction of course) but it didn't matter. Scripture I had just read the other day was coming to me right when I needed it (albeit I discovered I miss-quoted once, after I rehashed the conversation out with my father.) But still, I'm not discouraged. Do I have it all together? Of course not. Can I convert someone with my own silver tongue? Of course not. But what I loved the most about this experience is that the reason I didn't care what anyone thought of me was because I was filled with an inexpressible joy for my Savior, and I wanted to tell him about it. It overflowed out of me! It was the most amazing thing... may it always be like this, that I would be forever emboldened to share the Good News of Great Joy to all who will listen, and to those who listen, Lord, help them believe!
Last night I had a very long talk with a fellow co-worker about my Christian beliefs. It was, in fact, a three-hour conversation. (It was a slow night, what can I say?) It provided the opportunity for basically everyone in the ICU to hear about my devotion to Christ. Our debate ranged everywhere, from creation vs. evolution to the divinely inspired word of God vs. a book written by a bunch of drunk men to heaven and hell vs. ascending into another plane of existence to God's sovereignty in suffering vs. happenstance to Predestination vs. Free Will, we're talking some very heavy issues here.
The majority of instances when I have these types of conversations I am always so afraid. Afraid of what other people will think of my stance, afraid of being shunned by friends, afraid of saying the wrong thing, afraid of not knowing what to say. Last night I was bold in my conversation, I was always able to answer his questions (not to his satisfaction of course) but it didn't matter. Scripture I had just read the other day was coming to me right when I needed it (albeit I discovered I miss-quoted once, after I rehashed the conversation out with my father.) But still, I'm not discouraged. Do I have it all together? Of course not. Can I convert someone with my own silver tongue? Of course not. But what I loved the most about this experience is that the reason I didn't care what anyone thought of me was because I was filled with an inexpressible joy for my Savior, and I wanted to tell him about it. It overflowed out of me! It was the most amazing thing... may it always be like this, that I would be forever emboldened to share the Good News of Great Joy to all who will listen, and to those who listen, Lord, help them believe!
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