Thursday, December 25, 2008

Holiday Gathering


Christmas eve. A blanket of snow is sparkling under the moonlight bathing the city in a pale frigid blue light. Families and friends eating, drinking and dancing can be seen in many ochre hued windows on a quick glance. A lone woman is lying face down in a puddle of dark icy water and snow in an alley. She is brought to the ER for acute alcohol poisoning and hypothermia. Her daughter and husband are at her bedside crying because they know that this is not the first time she has done this. They are crying because they know this is not the last time she will do this. There is blood on her shirt. Her clothes are quickly cut away exposing a minor stab wound. Her family keeps to the side crying softly while nameless faceless scrub clad men and women start to fix her body knowing her spirit is broken. She starts to seize and vomit leaving behind an acerbic stench of stomach acid, bile and alcohol. Her family keeps to the side crying softly while monitors beep and hum. Maybe this is the last time she will do this.

Wednesday, December 24, 2008

Drunken Sesame Street

Maha to Drunky: Take this – its thiamine
Drunky: (slurred) What’s thamamine?
Maha: Its vitamin B
Drunky: Vitamin B for booooooooze!
Maha: You just destroyed my will to live.

Monday, December 22, 2008

Marriage Proposal


On a rare night, I looked surprisingly less haggard than usual (perhaps the new haircut helped) when I received a new Drunky-McD. He was naked waist down – EMS removed his pants because they were covered in snow and replaced them with a sheet. Poor bastard was under the impression that I took of his pants so he kept leering at me. He wasn’t giving me a particularly hard time except repeatedly asking for vodka in his orange juice and trying to guess at my ethnicity. His guesses ranged from Chinese to Spanish to Middle Eastern to East African (keep in mind, he’s DRUNK). When he finally gives up, he clumsily grabs my double gloved hand (because he’s got some dried vomit artfully decorating his shirt) and asks me, “baby marry me” before vomiting up some more bile. My coworkers’ barely suppressed laughter and snorting provided the soundtrack to this touching scene. After I told him that I don’t consider men with EtOH levels of greater than 20 suitable husband material, I could do nothing but laugh at how I had to reject my drunken suitor! Only in nursing.

Saturday, December 20, 2008

An Unjust Punishment

Last week I was called into my bosses’ office for a work performance evaluation (ie: encased in a small space that might as well have had a little demon with a pitch fork nudging me forward into a pit of open flames). Long blog post short, I’ve been told that I’m unorganized and anti-social. Usually there is a grain of truth to any criticism (especially the anti-social part) but this time I’ve been wronged!

I realize that since I’m new I have a bit (fine, a whole hell of a lot) of work to do to improve my organizational skills but being placed in the drunk tank almost every shift with virtually no equipment doesn’t help to improve organization – especially when I’m running around the department trying to find a freaking IV pole or a vital sign machine. Terrible.

I just got an email saying that she needs to keep a closer eye on me so she’s putting me in the psych/drunk tank area for the next several shifts. Hopefully I’ll have some fun stuff to post about but in the meantime, I’m going to relish my last several hours of freedom before being placed in my most hated area for the next 3 nights. Hopefully the massive snow storm and -20 windchills will keep people indoors and away from my area!

Sunday, December 14, 2008

Ideal vs. Real

Sometimes during shifts I imagine what my ideal day involving work would be like. At this point I stare dreamily into space (or start doing the sleepy head bob) and start going through ideal scenarios. After many hours spent trying to avoid work, I’ve come up with the following as my ideal day.

Wake up thoroughly refreshed and run for 45 minutes. Take a shower, get dressed, have my hair arrange itself perfectly and merrily walk to the train station. When I get to work, I’d give the Starbucks guy a winning smile while ordering my latte and perhaps flirt a little (he’s cute!). When I get to the ER, I receive a perfect report that only includes what the patient came in with, the plan for the patient and what I have to do. I complete my assessments and interventions flawlessly while amiably chatting with fellow coworkers. I receive patients who are pleasant and don’t ask for narcs every 10 minutes. The docs write sane orders in legible handwriting and understand if there are delays from the lab. At the end of the day, I merrily go back to the train station after meeting up with friends for a treat before going home. When I get home, I’d shower, eat a delicious yet nutritious dinner and then crawl into bed and sleep a peaceful and restorative sleep.

Unfortunately my real day goes something like this:
I wake up 30 minutes late and first words out of my mouth are ‘OH CRAP I’M GONNA BE LATE AGAIN!’ I blindly find my way to the bathroom and stub my toe unleashing another deluge of profanities and then get dressed. I run like a madwoman to the train station and barely make it on only to face the glares of the commuters who made it on time. I catch a glimpse of myself and look something like this but am too drowsy to care. I glower at the coffee guy when he gives me a large instead of an x-large and wish a pox on his house. I stumble my way inside to be assaulted with a needlessly boring and drawn out report and then realize that there’s a boat-load of stuff that needs to be done. When the doc decides to be bitchy about a lab delay I utilize my proxy vernacular of passive aggression and steal his pens before passing out during my break. After wishing I chose chocolate-taster as a career I give a scathing smile to the narc addict while telling him/her that they can’t have another dose while the charge nurse brings me a patient with a chart that might as well say colostomy bag explosion. At the end of my shift I pass out on the train (probably drooling) and count-down to when my next set of days of begin. I get home, shower and furiously stuff my face before crashing and repeating the whole thing again the next day!

Clearly my ideal and real days are lacking some congruency but for the most part, my real days don’t have quite such an acerbic flavour as the one I’ve described above! What’s your version of an ideal day? What’s your real day like? Share please!

Monday, December 8, 2008

Special Delivery at 0230

During yet another night in which I was estranged from my lavendar-vanilla scented bed, I was overhearing two nurses discuss their pregnancies and asking me when I was planning on having a child of my own (not any time soon considering I'm currently lacking a suitable donor for the other 23 chromosomes :P ). I politely excused myself to undertake a frivolous and potentially risky adventure to the 24 hour coffee shop when a slightly crazed man bursts through the doors and screams, "my cousin is in the car having her baby RIGHT NOW!" Sure enough, I see a car outside with a woman whose face is grotesquely distorted with pain and a man looking stricken with panic. The charge nurse sees this and gets into super-nurse mode. He starts barking orders left and right and screams at me to bring a wheelchair. For once I was (slightly) ahead of the game and wheeled one over to the car and opened the door for the woman. Turns out her cousin was right - she was having the baby right now. Right now as in the head was out! The wheelchair was useless. I ran to get a stretcher and some blankets for her. By this time, the paramedics were helping and security was calming down the waiting room. We got the woman on the stretcher - my charge nurse was on the stretcher assessing the situation, the ER doc was barking orders that I didn't hear, the dad was saying something about the water breaking and I was holding on to the side of the stretcher trying to put in a saline lock. We wheeled her into a room just as the the OB-GYN, L&D and neonatal mafia swarmed the room. Within 10 minutes we were admiring a beautiful pink and shrieking baby girl! Some of the patients came out of thier rooms to see the commotion and applauded when they heard the baby crying! Mommy and daddy were crying tears of joy while the cousin was just beaming. The family was quickly taken up to the L&D floor while I was left thinking that nights like this make night shifts worthwhile. The adrenaline rush also kicked coffee's ass in waking me up!

Tuesday, December 2, 2008

The Honeymoon is Over




Lately I’ve been feeling down about work. Despite the fact that I’ve been working more independently, I still feel like I either work only slightly faster than a speeding slug, get caught up with other nurses’ bullshit and/or get stuck with asshole drunk patients. I also feel like I’ve hit a plateau in my learning and I’m stuck in the endless cycle of scut-work.

The other night I got a set of admission orders that included a dose of IV Cipro. I fax the orders down to the pharmacy and get a requisition ready to order it from central dispatch (drugs that are not stocked on the unit are sent to us by central dispatch during night shifts so a form has to be faxed to them – they deliver whatever is needed in 5-10 minutes). I get everything ready and start walking towards the fax machine when another nurse walks over with the bag, hangs it up and tells me that there’s a ‘secret stash’ of Cipro in the back rooms. Great. But how the hell was I supposed to know about secret stashes? I got irritated because I just wasted my time filling out the damn forms when I could have resited her IV and saving me a hell of a lot of time.

Yet another nurse that was preceptoring me has a thing against ‘fussy’ old people who ask for things when she’s busy planning her upcoming wedding. I’m mighty pissed at myself for giving into her way of working when I really should have had the balls to stand up for myself and the patient. This nurse had me convinced that since the patient was 99 years old and had a history of bone mets, she was not able to walk and she could not get hot water for tea (even though we were sitting on our asses doing nothing). She told me that if I tried to make her walk and she fell it would be my problem when our manager finds out about it. Fair enough. Except I never gave the patient a chance to explain herself and she ended up sobbing in her bed. I was aghast at myself for having made an elderly lady feel this way. I know that the ER is a busy and fast paced environment but I sure as hell would not want to be treated like a crazy piece of crap by a kid with 3 months of nursing experience when I’m elderly.

Since I can speak two other languages (besides English), some of the docs also ask me to translate for them. When this happens during a time when I’m really busy, I tell them to hold off for a little while unless it’s an emergency involving the ABCs (yes the nursing school basics), In that case, I quickly tell the patient what’s going on and when I can return. I know that I can’t be abandoning my own patients to run away and translate but that’s what we have float nurses for. When a situation like this came up, another nurse got pissed at me for taking too long translating! She told me that I should have told the doctor to hurry up with his assessment. Again in some cases that’s fair. But this was an exceptional case because the patient that I was translating for was a suicidal refugee who lost his wife and daughter in a bombing. That requires some diplomacy, tact and sensitivity – it most certainly is NOT the time to tell the doc to hurry up because I have to go triple chart on some mundane intervention. When I tried to explain this to her, she just mumbled something along the lines of ‘you weren’t hired as a translator’.

On top of this, I feel like a glorified babysitter when I have to deal with belligerent and violent drunks that constantly come in every Thursday, Friday and Saturday nights. I’m so sick of calling security to wrestle them down so I can put in yet ANOTHER line into them, hydrate them, give them a sandwich and kick them out in the morning just to have them come back the next week. During my last night shift, I was particularly infuriated with my entire patient load because you guessed it – they were all bloody drunks. I don’t feel like I’ve gone to school for 6 years just to babysit violent 300 lb men with drinking problems with ensuing incontinence and send them away with a smile and a breakfast at the end of my shift.

Not surprisingly, I feel the happiest at the end of my set of shifts because I know it’s the longest time before I have to come back into work. Likewise I feel the most depressed the night before my next set of shifts starts. The honeymoon is most definitely over. Work sucks something mighty fierce.

Saturday, November 29, 2008

Dumbest. Code. Ever.


During my morning break, I staggered my way over with an unsteady gait to Starbucks. Lots of other employees were doing the same so naturally there were a lot of people around. There is a gift shop, a drug store and the info desk right in front of the Starbucks so many patients and families are also in the area. For some reason I noticed a lom with an oxygen tank and mask making his way through the gift shop. Apparently there was some resident who was meandering about as well when the lom started gasping for air and turning blue. The heroic resident quickly called a code and in the commotion I made my way over to see what the big fuss was all about. Turns out the tubing got disconnected from the tank when the lom tried to reach for a magazine from an awkward corner. So I reconnect the tubing with the lom returning to a normal colour and unlaboured respirations. This is when I see the code team (which consists of half the ER staff) rushing towards us in a giant kurfluffle looking to save lives and look good in front of the myriad of highly attractive women in the vicinity! One of my coworkers got completely confused when he saw me and asked what was going on. When I explained the situation to him, his worried expression transformed swiftly into one of profound disdain and disappointment followed by the words, “what the fuck man?” as he storms back to the ER. The code blue turned out to be a code bust leaving the resident exceptionally embarrassed.

Friday, November 14, 2008

From Kensington Palace


Sometimes there are some real pieces of work that walk in through the ER doors. Two nights ago my preceptor asked me if I wanted to try to triage a few minors just to get some experience. I was more than happy to get out of observation so I followed along. All was going well until a 40-something year old guy walks in. Actually, barges in is more like it. He immediately declares that he needs an x-ray of his belly. When I asked him why he thought he needed an abdo x-ray he looks me dead in the eye and states, “I’m pregnant – can’t you see that?” Ummm… no! I tell him that he can’t be pregnant (because he’s lacking the requisite parts) but he will be seen (and not shortly either). This sets him off even more and he starts screaming, “I’m pregnant! I’m pregnant! I need to see what my baby looks like!” Of course at the moment I heard the entire waiting room turn around to witness the freak show unfolding. He carries on screaming about his unborn child while my preceptor calls for security. The sight of security calmed him down enough for me to ask him name. He said it was Diana Spencer, better known as Princess Di. This just sets me off and I start to giggle (very professional, I know) while my preceptor takes care of the paper work.

Eventually he gets brought in and placed in the psych room. I also go back to observation but when I walk by the psych room he stops me and asks me for a pen. I saw him writing furiously so I figured why not and gave him my cruddy pen. About 20 minutes later, I walk by the room and I see his face covered in pen marks and he managed to wrap his head with medical tape! I asked the security guard about where he got the tape from and he told me that Princess Di was crawling around on the floor writing in “pregnancy pain” when he found a roll of tape under a chair and proceeded to tape his head! I wish I could have violated patient confidentiality and taken a picture because I’ve never seen anything quite so bizarre! The wrapping looked like a mummy’s bandages! Several minutes later Princess Di has to go to the bathroom. The security guard obliges and waits outside the door. When it was taking too long, the guard went into the bathroom and found him seran wrapping his chest and abdomen. I snuck away once again from observation just to be a part of the show! The on-call doc walks by, stops dead in his tracks and says, “Diana, I just saw you yesterday! What the hell is your problem now? You better not say you’re pregnant again!” Princess Di looks sheepishly at him and tell him that he wrapped himself for the x-ray so the baby will be protected. Oh good lord this man was insane (probably literally)! The doc just grabs the chart out of the nursing station, discharges him and tells him to get out! Princess Di threatens to report the shabby care he received to M15 and the Queen of England because she is his “mother”. Riiiight.

About an hour later, he walks into the waiting room and towards the triage desk again but this time the triage nurse tells him that the ER is closed – there’s too many people! He gets confused and bewildered and stumbles out of there. He didn’t come back for the rest of my shift but I’ve been told to keep an eye out for him because he’s almost frequent flyer number 1!

20+20 = 40

I had a patient come in for a prescription refill early on in my shift. He needed 40 mg OD, PO Lasix for a month, meaning he needed 30 tablets. Nothing unusual about that – we get a lot of people who need prescription refills and I’m more than happy to get the refillers seen quickly, especially when they DON’T need narc refills. So this guy gets his prescription filled and leaves. 45 minutes later he bursts into my area and starts yelling at me telling me that the “idiot doc got me the wrong dose”. Surprised and flustered (because this particular doc is a border-line perfectionist) I ask him to let me see the container. I read the label which says something along the lines of 60 20mg tabs. I point this out to him and he incredulously looks at me and says, “It says 20mg not 40! Are you illiterate?” I start to lose my patience and ask him, “what’s 20+20?” He replies, “40!! What is your f@#&%k point??” My f@#&%k point is that if you took TWO 20 mg tablets for a month, it would be the same dose you mathematically illiterate idiot! It took me a good 20 minutes to explain this concept to him. Did I mention that pre-temper tantrum he said that he’s a teacher? I fear for the future.

Thursday, November 13, 2008

Conscious Sedation Chats

Happened while prepping a pt for conscious sedation for an I&D

Doc: Okay dear just relax and think of pleasant thoughts.
Pt: Man I’m thinking I look like Halle Barry! Life is gooooood!
Doc: What’s a halle berry?
Pt: DAYUM doc you one OLD DOOD!
Me and 2 other nurses: Giggle snort chuckle!
Doc: Just push in the stupid fentanyl!
Me: Sure thing – giggle snort chuckle!
Doc: Glares at everyone in the room

Monday, November 10, 2008

Clueless

27 y/o woman comes in with ++nasal congestion and watery eyes.
States symptoms started yesterday and generally experiences similar symptoms with onset of cold weather which resolve in several days.
Denies fevers/chills.

O/E:
Productive cough with yellow sputum.
No pain on inspiration.
Lungs clear bilaterally.
VSS.

Diagnosis:
COLD!!!! WTF people??? You wake up and think "hmm... sunday morning, now is a good time to go to the neighbourhood ER?? GET A LIFE!!!

Thursday, November 6, 2008

Diagnosis – Degenerate

17 year old girl comes in with her douche bag of a boyfriend complaining of abdominal pain, distension and vaginal discharge with whitish tissue. When asked when she had her last period, she says 2 months ago. When asked if she has unprotected sex she says ‘all the fucking time’. When asked if she thought she could be pregnant she gets a deer-in-the-headlights look and says, ‘but he doesn’t cum in me!’ The boyfriend emphatically supports this. Then he asks, ‘but couldn’t her gut be hurtin’ cuz I fucked her too hard in the ass?’ Ew. No you degenerate assbag it’s because she’s pregnant and miscarrying. Some people seriously should have IQ testing done before attempting to reproduce.

Baptism by fire


Several shifts ago, I walked in feeling good, feeling confident and generally feeling fine about the night. I put away my coat, got out my ID and stethoscope, greeted my coworkers and started walking on over to the assignment board. And that’s when I experienced a moment of asystole and then rapid tachycardia. My name wasn’t paired up with a preceptor. ‘Surely this must be a mistake – the ward clerk made a mistake. This HAS to be a mistake’, I thought in a panic. Unfortunately it was not a mistake. The charge nurse strolled over and told me that the unit was extremely short staffed and she thought I could take on the assignment by myself. Apparently 4 nurses called in sick. Damn flu season.

So I try to pull myself up by my bootstraps and head over to the fast track area (seems to be where I’m usually placed). I have 8 patients and a very worried day shift nurse waiting for me. Report sounds something like this;

‘Curtain 1 is a 33 year old guy came in with coffee ground vomiting. He’s got 2 boluses of fluid and needs a pantoloc infusion started along with another PIV. He’s due for another CBC in two hours and he’s waiting for a GI consult. Keep a close eye on him. Curtain 2 is HIV/HIT positive and came in for query pneumonia. Her sats are now in the low 80s. She’s gonna need help and lots of it. Oh she’s also isolation for ESBL precautions. Watch out – she’s kind of a bitch and may try to hit you or rip of your mask. Curtain 3 is a homeless lady, EtOH abuse, left elbow cellulitis and waiting for an ortho consult to rule out septic arthritis. Her morphine tolerance can rival that of a large baby elephant so keep on signing out as much as you need but keep an eye out for respiratory depression but you knew that hahaha! Curtain 4 is another homeless EtOH abuser and is VERY tremulous. He needs hourly IV diazepam. He’s to be discharged when he stops shaking. Curtain 5 is a lol who’s waiting for a bed in medicine. The resident wrote a shit load of orders for her. My advice would be to start her cipro, ancef and avelox and let the floor worry about everything else. Keep an eye out on her I&Os cuz the resident is really anal about it. Jerk. Curtain 6 is a perforated appendicitis but GI can’t take her right now because they’ve got 3 urgent cases lined up ahead of her. She’s got admission orders so start her antibiotics quickly. Oh and she’ll probably be spiking a fever soon. Do hourly vitals on her cuz she just doesn’t look right. Good luck hon – make sure you ask for help. Good night’.

When that report was finished I wanted to hide in the bathroom and cry. Turns out that between patient transfers to the floor, I went to the bathroom and experienced what could be my first ever panic attack. I was definitely tachy, diaphoretic and vomited. Had I been older, I would have thought I was having an MI. Not a good patient load to start of with when I'm still a newbie. I don’t know how I managed to survive that night – all I remember is that my priority was sticking on high flow oxygen to bitchy HIV lady, getting pantoloc to coffee grounds guy, antibiotics for old lady and perforated api woman while begging admitting to find beds for the ones who were waiting. When I finally got a bed for my perforated api lady, I realized that I forgot to give her Tylenol for her fever. Since Tylenol was not in her admission orders, the medical directive becomes void on the floor. The floor nurse made sure she bitched at me. Funny thing is that I had Tylenol in my pocket and was willing to sign on the chart for it but she wouldn’t let me. Her problem.

Not that I want a night like that again, but looking back on it I got a month’s worth of learning in 12 hours. Sure I needed a stiff drink after that but since it was morning time when I was finished I just crawled up in my bed and tried to forget that any of the night actually happened. My boss is telling me that she wants to test run another independent shift in a few days so I suppose I better I get my butt into gear and get ready. I don’t wanna!

A good man

My faith in humanity has been restored once more. Before a night shift, I always end up getting a vanilla bean latte but last night my heart broke when the (incredibly cute) barista told me that the espresso machine was broken. Hovering somewhere between depression and panic at not being able to meet my nightly caffeine requirements, I wondered what else I could drink that would sustain me for at least half the shift. And that’s when he made me a ‘fake latte’ – he mixed in just the right amount of vanilla flavour and milk in the caramelo and handed it over to me! Unnamed barista, thank you for making a yummy and functional drink that allowed me to see a boat load of patients without losing my mind for half the shift. I’m officially in love with you!

Unfortunately named

Dr. Hung for swallowing assessment.

My apologies to Dr. Hung but he provided hours of entertainment for us weary night-shifters! And yes, I'm very immature at 0300.

Monday, November 3, 2008

Pearls of wisdom from violent drunk/psychotic dood

“Hail Satan motherfuckers!”
“Your mom sucks cock”
“Your mom sucked my cock you faggot” (to security guard)
“I’ll light your dick/vagina on fire bitch” (that one is actually pretty good no?)
“Jesus is dead bitches – I killed his ass” (no comment)
“I feel like shit assface” (after throwing up three times)

I’m always surrounded by classy gentlemen. This guy was screaming like a maniac on the top of his lungs AFTER 10 ml of Haldol. It took six big burly security guards to restrain him and even then he almost turned over the stretcher. Being forced to listen to that jackass made me realize how glad I was to be working with nice, normal non-psychotic women with pregnancy concerns.

Sunday, November 2, 2008

Hydration is key

Guy comes in on Halloween night with a serum alcohol level of 87, tested positive for amphetamines, benzos and cocaine is staying as a B&B patient. In the morning one of the residents calls a bunch of nurses over and points out party-guy gnawing on his IV tubing while making asinine tranquilized animal-like noises. When he finally wakes up several hours later, he states he feels like he was eating or drinking something salty. The guy managed to gnaw through his tubing and drink the normal saline. At least he was hydrated.

Warning – angry rant ahead

Today was a great day in terms of learning complicated nursing stuff like trauma. That’s right – I got to work my first trauma! Actually the only thing I did was push in amiodarone and atropine. After that I retreated back to documenting.

Now to put the anger into perspective – prior to receiving trauma-man, I got a patient with query hip fracture and ++ nausea complete with her insanely bitchy daughter in tow. The daughter hovered around the nursing station like a vulture ready to descend down on her pray and hack them mercilessly with mind-numbingly idiotic demands. Such demands included, “my mother should be allowed to eat” (before an unnecessary abdominal CT? get a life), “take her to the bathroom right now” (I don’t get paid enough to be your personal bitch) and last but certainly not least, “these sheets are much too rough for her skin so go get her something softer” (Do I look like the manger of the fucking Hilton? Go fuck yourself and then head over to a department store if you’re that concerned).

During her concerted efforts of putting the retard back into retarded, we got a call from EMS saying they were bringing trauma-man to us with an ETA of 5 minutes. Naturally, we all rush into the trauma room and get it prepped. I was getting the IV pumps and the cold lactated ringers prepped when I spotted the vulture. I ignored her and along with the trauma team ran over to the EMS crew to get report and start documenting like my life depended on it. When I was back in the trauma room and drawing up atropine (which has a half life of about nothing), this fuck-tard of a woman BARGES in and demands that either myself or my preceptor take her mother to the bathroom RIGHT NOW! This was the moment that I lost it at this woman. I was blinded by a ball of white fury so I don’t remember much but apparently I screamed at her and told her to get out and stay out if she doesn’t want to be thrown out by security. She walked away in a huff and then threatened to sue me.

You know what I have to say to you lady? FUCK YOU! How far up your ass is your head stuck that you can’t understand that a guy suddenly lacking vital signs with 50 people hanging every single drug known to mankind is less important than your mother’s voiding needs, who by the way is perfectly capable of walking! You asked for Vaseline earlier? I’ll get you a boat load of Vaseline and try to pry your head out of that entitled ass of yours. And then give it a swift kick for the good of the country. Your parents have failed as human beings by not putting you in a reed basket in the middle of a Florida swamp filled with ‘gators upon your birth. If I have to be sued by you, I’d love to see your uppity ass trying to defend your mommy-dearest having to hold it in while the rest of the team tried to SAVE A LIFE.

Idiot people just grate my nerves more and more everyday.

Saturday, November 1, 2008

T.M.I.

Two nurses talking to each other about a dance lesson poster in the staff lounge;
Nurse 1: Did you hear about those dance lessons?
Nurse 2: Yeah I did but my husband won’t go cuz he’s a crappy dancer.
Nurse 1: My husband sucks at dancing as well – the only dancing he’s good at is between the sheets and even then I have to fake the shakes.
Nurse 2: 0_o - You need a new husband.

Thursday, October 30, 2008

The non-medical benefits of medical tape

I live in Canada and its getting progressively cooler, yet until recently I had no winter coat. My last coat had been reduced to nothing but a polyester shell of its former snuggly existence. So off I ventured into a crowded mall (places with a large amount of people now freak me out for some reason - I think someone might fall down the stairs and on my next shift I’d see them wincing in pain) to troll through numerous stores and aisles. My venture was met with success – I walked away with a stylish, warm and grossly overpriced coat. However when I attempted to get through the entrance to the subway, my bag got caught in the revolving door and it ripped leaving my shiny new purchase exposed for all to see. That’s when I started to dig around my oversized bag for a roll of tape and then realized that in an attempt to temporarily shed my nurse identity, I cleared out my bag and left all my supplies at home. Medical tape would have been greatly helpful in patching up my now extremely ghetto looking shopping bag. Lesson of the story – don’t ever leave your house without wallet, keys, phone and tape.

Tuesday, October 28, 2008

Boy nurse: I think my little old lady tried to sexually harass me!
Nurse 2: What the hell? How?
Boy nurse: She tried to grope my ass when I turned to hang her antibiotics!
Nurse 2: She is demented though – maybe she was just flailing her arms and one hit you.
Boy nurse: Then why did she wink at me?

A wicked case of crotch rot


My charge nurse handed me a 16 year old girl who was transferred over from one of our affiliate hospitals for pelvic inflammatory disease accompanied by her boyfriend who looks just like a gangsta wanna-be would in a place where his greetings of ‘s’up muthafuckahs’ are met with disdain – like a stray puppy who’s angry at being placed in a kennel for the night. The girl herself was pleasant enough – actually she was quite sweet. I did my assessment and then set up the room for one of the residents to do a speculum exam while explaining the process to the girl. So along comes the resident and starts doing the exam. Now I know this guy a little bit and he knows that I’m new so whenever we’re working together he tries to get me to see as much as possible, which is always appreciated. Usually he explains the procedure as he’s doing it but this time he asks me to come to his side and pass him an instrument while looking at me somewhat funny. This of course makes my spidey-sense tingle and I quickly walked over to his side. When I looked at the vajayjay area I was horrified. I had never seen that much curdled cottage cheese like discharge from an area that small before! The resident took out the speculum and it was dripping with the aforementioned discharge! I can’t even begin to describe the smell. Meanwhile the girl is asking ‘what smells funky?’ That would be you honey. When we explain what we saw, she says, ‘But I’m not a slut! I’ve only been with a couple of guys! Did you put the thing in the right hole?’ What we saw shouldn’t be coming out of any hole. We were concerned about the boyfriend as well so we brought him to another room to chat with him. Turns out he was admitted a little while ago for the same problem but he had been compliant with his meds – the girl hadn’t. She ended up getting a gram of vanco for chlamydia in the ED before being admitted to gyne. Needless to say she needed a LOT of health teaching and perhaps a swift kick in the ass for thinking unprotected sex with ‘only a couple of guys’ guarantees protection from STIs!

A testicle is worth 4 hours more than an ovary

28 year old woman walks up to triage looking obviously distressed and in pain. She complains of severe 10/10 LLQ pain. Blood work is drawn and sent to rule out appendicitis and ectopic pregnancy. While waiting for the blood work, she drops the bomb on us – “I had a right salpingo-oophorectomy because of ovarian torsion and I’m afraid the same thing is happening again”. The docs and residents went into panic mode and started calling imaging for a stat ultrasound. The radiology residents said that they would not do an ultrasound unless they get the hCG levels to rule out ectopic pregnancy. Maybe this time around radiology got stuck with a bunch of residents who have shit for brains since an ultrasound provides the definitive diagnosis of pregnancy/structural gynecological issues. Understandably the staff ER doc and ER residents went ape shit and finally got a hold of the staff radiologist who then screamed at his residents for being incompetent buffoons. In the end, it took the poor woman FOUR hours after presentation to get to the OR. Last I heard was that the surgeons found the ovary with arterial blood supply compromised but venous flow uninterrupted. They left the ovary in to see if it might heal. This woman has been wanting to have children since she got married several years ago and felt that now the time was finally right. What kills me is that when a man presents with testicular torsion, a white coated army descends down into the ER faster than you can place a page. I realize that ovarian torsion is much less common than testicular torsion but the woman has a history and records. Why anyone would want a pointless blood test to perform a test that can see the source of the problem directly is beyond me. I really hope this woman’s ovary heals and she can have children. If she decides to sue the hospital, I wouldn’t be surprised – hell, I’d probably support her.

Wednesday, October 22, 2008

The difference between a few centimetres

I walk over to triage and rummage through charts that have been assigned a less urgent/non-urgent score and pick one up that says groin laceration. I call the patient (who happened to be an incredibly good looking man) and start to lead him to the suture room and notice he is walking very carefully. I read over the chart but I wanted to get the story myself. Turns out he was playing hockey, tripped and then got a cut in his right groin from another player who tripped over him. It wasn’t a horrible laceration – no profuse bleeding, no signs of hypovolemia and no pain. In fact, most of it was quite superficial except for a 0.5 cm area that was bleeding very very slowly. He ended up getting a souped up bandaid, a tetanus shot and a good luck before being discharged. One of the residents summed the case up very nicely – “a couple centimetres more medial and… ooohhhh” (as he crossed his legs and winced in pain).

Proposition

An aggressive drunk guy in restraints thrusting his pelvis at all the female staff in his line of vision and screaming, “Suck it baby! Blow me hard!” The doc walks over and tells him, “not gonna happen tonight” before giving him IV diazepam. Good times.

Mean Girls


Yesterday morning at around 0630 (why an hour before shift end? Why?) I got assigned to a mean girl (with her mean girl posse in tow) complaining of carbon monoxide poisoning. So I dragged my mildly nauseous, severely bleary eyed self to the exam room and started my assessment. Each question I asked was met with the trademark mean girl death stare from her and her posse before she managed to spit out an answer. I started by asking her what made her think she had carbon monoxide poisoning to which she replied, “my friggin carbon monoxide detector like totally went off so like whatever”. Right. I just couldn’t resist so I asked her, “did it ever occur to you on your long drive over that maybe the detector isn’t working well?” I was met with the death stare and another “whatEVAH”. So I carried on my assessment and asked her if she was feeling lightheaded, dizzy, nauseous, short of breath, feeling better outside the building rather than within, other people in the building complaining of the same symptoms or any flu like symptoms. Did I mention that her vital signs were unremarkable and her O2 sat was 100% on RA? She denied any symptoms and then asked “what the fuck does the fucking flu have to do with carbon monoxide poisoning? Gawd, are you like a fake nurse or like a tech or something?” Normally I put on my professional face and try to be as diplomatic as possible but I just shot back with my own death stare and told her that the doctor will probably need an arterial blood sample. When she asked where she’d get the needle, I couldn’t resist and told her that normally it’s obtained from the wrist but if he can’t get the artery, he might need a sample from the groin. Her shocked look of horror made my night but unfortunately it wasn’t enough to stop her bitchy remarks. While the resident was getting the sample, I had a bag filled with ice and a requisition prepared so she didn’t have to stay a minute longer than necessary. The mean ditz then told the resident to “check over her shit cuz she asked me like the dumbest fucking questions”. Luckily for me the residents and staff docs I work with are extremely nice and understand that I’m new so he too shot her his own frighteningly effective death stare before saying, “my coworkers are among the best in the country so I don’t need to double check their work” before walking out. Turns out her carboxyhemoglobin level tested at 0.0000 which pissed her off even more but there was nothing more that we could (or wanted) to do. She dramatically told us that it would be our fault if she died before calling us retards and storming out. Another chart in the discharged pile.

Tuesday, October 21, 2008

BIG babies


I love working in the fast track area. I get to see lots of patients, usually end up fixing their problem and then sending them home. It’s a great feeling mostly because they don’t stay long enough to start grating my nerves. That however was not the case during my last shift. I got an extremely rude and entitled 40-ish year old guy who came in complaining of back pain. Of course he was in obvious pain but he was well looked after. He got 6 mg morphine IV push initially and got settled into the stretcher. And that’s when he started. “Maha, I still hurt. Do SOMETHING”. “Maha, get me another pillow”. “Maha, I’m thirsty again but I don’t want the pitcher of water. I just want the little cups for each sip with filtered or vitamin enhanced water”. “Maha, my IV feels weird. I think I need more pain meds. Didn’t I already tell you to do something?”

What I wanted to say to him was, “You just got 6 mg morphine half an hour ago. You’re not getting any more from me for a while even though I’d love to see your respirations drop at this point. We’re severely short on pillows so thank your lucky stars that I rummaged all around the unit to get you one while the doc was getting pissed at me for not helping out more quickly for a conscious sedation as well as having to look after 10 other people. NO you can’t get a fresh new paper cup for each little sip of filtered and/or vitamin enhanced water you inconsiderate jerk! It’s bad for the environment and look around you – this isn’t a 5 star restaurant and I’m not your waitress here to kiss your monkey ass so you’re getting the giant pitcher with good ol’ ice water! If you keep picking at that damn IV I swear I’ll use a 16 gauge in the smallest vein you’ve got and then smack your dumb ass with the IV basket before giving you more meds!”

What I ended up saying was, “Sir, you can’t get more morphine for at least another 2 hours. Try deep breathing instead. Unfortunately we don’t have any more clean pillows on the unit. We’re an environmentally conscious hospital so we try not to create unnecessary waste. And the government does not give us enough money to buy vitamin enhanced water – we usually spend our money on equipment and medications. Please stop picking at your IV because if it comes out, we’re going to have to re-site it which as you know hurts.”

Not to be a total bitch about pain (because it hurts after all) but it’s really irritating to see people in moderate amount of pain being assholes making idiotic demands while someone in unimaginable pain thanks you profusely for everything you’re doing for them while suppressing a sob. Needless to say I wheeled him out after his discharge with a huge smile.

Shift End Pages

“Whoever took 4 mg of morphine from resus and did not sign it out, please walk over and sign with your head hanged in shame for making me stay past shift end. Thank you.”

Saturday, October 18, 2008

BD Passive Shielding Blood Collection Needle


ER nurses have to collect a lot of blood. Many times it’s from patients that are either acting like total douche bags or from HIV/Hep C positive patients. My unit also uses a lot of butterflies to collect blood. I have also used my fair share of butterflies because they are really easy to manoeuvre but I can never activate their safety feature with one hand. I’m of course reluctant to put my hand near a used needle to try to cover it up. I also find that sometimes I can’t draw blood fast enough even when I see flash in the chamber. On top of all that, half the time the lab sends back a report that tells me I need to draw up another set of INRs/PTs because the first sample did not yield adequate results. Patients really love me when I have to tell them that they’ll have to wait for at least another two hours and that I’ll have to poke them again. But then I discovered the passive shielding blood collection needle. I freaking LOVE this thing! I get the vein EVERYTIME, get my blood drawn super fast and don’t get back angry lab reports. The passive shielding needle is a bit harder to manoeuvre than the butterfly but once you get the hang of it, you can’t go back. Best of all, as soon as you withdraw the needle, the safety shield clicks in automatically which means I have no chance of getting a needle stick when someone flinches their arm away or decides to have a seizure in the middle of venipuncture. I’m still working on my dexterity with this, but I think I’ll be reserving the butterfly for really tiny veins and smaller people.


I realize that this post sounds like a total testimonial for the BD folks, I (unfortunately) was not paid to write this. Its just something I now love! And yes, I’m a big time nerd.

Friday, October 17, 2008

Abscess from HELL


I had a lady come in complaining of pain in her butt. Literally. She said that it hurt to sit and it felt like there was a pimple there that was pushing out other tissue. Sure enough there was a giant abscess and was right in the middle of her butt. In case you're wondering what it looked like, here's a picture of an abscess on a leg. Imagine that on your bum. Ouch. I was surprised as hell when one of the docs (who knows I’m a complete newbie) asked me to assist during the I&D but nonetheless jumped at the chance to see something gory and bloody. I was not disappointed. When the doc made the first incision, I gasped at the amount of pus that started to gush out of the abscess. I think it had to be about 50 cc. I haven’t consulted literature regarding average pus volumes in abscesses but that seemed like a lot. Apparently this woman had a history of abscesses in that region. Trying to critically think about why that could be, I started talking to her and found out that she used harsh soaps and scrubbed extra hard to “get rid of the bacteria”. Poor woman – she just kept breaking down her skin and letting the bacteria get in. Moral of the story; be kind to your behind.


Thursday, October 16, 2008

From nursing student to NURSE

It has been a long time but I’m back – with a nursing degree and a (temporary) license! After finishing my consolidation, I landed a job in an ER right smack in the middle of the big city! I’ve been working there for a little over a month and so far, it’s not too shabby. The first couple of weeks were spent in orientation which included some mind-numbingly boring sessions (but paid and with free breakfast) on hospital philosophy and policies on CBG testing.

Currently, I’m ‘buddy-shifting’, meaning that I’m following different nurses around trying to get the hang of things. Some of those nurses understand that I’m a new grad but I need to learn so they let me try to run things and help out when I need it. In fact, a couple of shifts ago, I was pretty much running the fast track area. I actually felt like a NURSE instead of a scrub clad monkey with opposable digits. On the other hand there are some nurses that just make me feel like crap. For example, yesterday I was working in the fast track area with a nurse who kept telling me that I’m insanely slow and that I can’t keep up with the patient load. She was right that I couldn’t keep up but I think it was partly because she kept slamming me with new patients every 10 minutes. When I worked the fast track area previously, I discharged at least 2 patients before bringing another one in so I could keep a stretcher free in case a lol (little old lady) with a query hip fracture is brought in by EMS. When I explained my reasoning to her, she just looked at me like I was a total moron and started giving me report on 4 new patients. There are some days when I get really pissed at myself because I keep forgetting the details about patients. I still feel like I’m having the hardest time remembering who is going for what test at what time. I feel like an idiot giving report while realizing I forgot about a test or a new set of orders.

Another shock to my (nursing) system was the sheer number of patients I can see in a given day. When I was consolidating on the floor, I memorized the patient list, admitting diagnoses and med times within a week. I got sick of handing out the same pills every day. In the ER, I can see up to 30 patients a day presenting with everything ranging from abscesses in the ass crack (its true) to bleeding eyes and insane joint deformities. Throw in the Friday and Saturday night Drunky McDrunkingtons (my pet name for the drunks requiring a B&B) and I’m well on my way to climbing the steep learning curve.

I really hope that I don’t screw up and get tarred and feathered out of the ER. Now that I’ve had a taste of the autonomy nurses can have, I really don’t want to go to another unit. Attaining competence, confidence and beyond is my biggest goal – I really hope I get there sooner rather than later.

Thursday, August 14, 2008

It's Over!!

A few days ago I finally finished my consolidation period. I’ve had a week to readjust to non-nursing life, which involved not waking up and sleeping and random hours of the day and constantly thinking about when I could nap next for the longest amount of time. It was especially difficult to get out of night shift schedule and fight the temptation to stay up until 0400 doing nothing and then not waking up utterly confused and disoriented at 1500-ish. Instead, I’ve been trying to get out of nursing jet lag and catching up with friends and family. I vowed to myself that I would not think too much about hospital life and nursing, but I failed. Instead, I delighted my non-nursing friends with great anecdotes like describing the appearance and odour of C. diff stool (green, mucusy and smells like rotten death) and how fast blood can ooze out of places that were previously held PICC lines. Seeing their green faces and frantic attempts to avert their gaze towards anything and anyone but myself reminded me that in the normal world, graphic descriptions of bodily fluids and odours are not tolerated well.

Even mundane chores like cleaning are reminding me of my nurse-self – so far I’ve found enough alcohol swabs to open my own store, medical tape, a few pieces of sterile gauze, endless amount of post-its with vital signs and room numbers, a few stolen pens (I’ve told my colleagues repeatedly – if you leave a pen near me, it will be mine), two 3 ml syringes, and a butterfly. I had no intention of taking these things home with me (except for maybe the pens) but since I’m too lazy to go back to my unit to return them, I’ll keep them as a souvenir of my time in consolidation.

On the other hand, it is getting much easier to indulge a few other loves of mine – namely reading magazines (give Bitch a chance) and baking. In fact, I’ve made an amazing carrot cake and banana bread so far. This leads to yet another point – ironically, I ate much healthier when I was working but now that I’m at home (and baking), I need to sample my creations (for umm… quality control purposes). My treadmill in the dungeon (the basement) will be paid a reluctant visit soon.

But while I’m glad that consolidation is over (working full time for free is not conducive to having a life that needs occasional bursts of consumerism), I’m scared of joining the ‘real’ world of nursing. For the past few months I’ve practiced under my teacher’s license which provided me with a palpable sense of security. Now that that security is gone, I’m shaking in my boots about having to be solely responsible for the consequences of my decisions. But the increased pay (from $0/hr to $more/hr) should help alleviate some of those anxieties!

Monday, August 4, 2008

The Cardiac Conduction System Explained

http://ambulancedriverfiles.blogspot.com/2007/06/sex-relationships-and-cardiac.html

Why didn't our pathophysiology teacher explain it like this? It would have saved me hours of reading and note making!

Saturday, August 2, 2008

I just got this link in an email and there is no way I can't share it!
http://www.emergiblog.com/2007/10/emergency-nursing-a-pictorial-essay.html#comment-130955

This Really Happened

On yet another night shift, I was sitting quietly in the nursing station at around 0230-ish reading a patient’s Vogue (I had permission and she was sleeping) when suddenly I hear “OH MY GOD! WHAT THE FUCK!?? WHAT THE FUCK??! GET OUT! GET THE FUCK OUT!” All of us ran to the end of the hallway where we see our previously pleasant 65 year old post MI patient in his bed. With another patient in his bed. A woman. Who was naked. It turns out that the woman was very confused (she couldn’t be oriented to her face, let alone the time) and so in her confusion, she stripped, climbed into his bed and then peed on this poor guy! If that happened to me, I think I’d probably have the same reaction. We apologized profusely to the man and tried to get the woman out of his bed. She stood up and with a misplaced sense of modesty covered her nipples but didn’t really mind that regions south of the equator were on full display. It took almost an hour for us to calm him down and we had to assure him that we would keep her bed in front of the nursing station so we would have our eye on her the entire night.

When we wheeled her bed over to the station, she asked ‘why am I here?’ to which another nurse replied, ‘because you stripped and peed on another patient’. She let out a laugh while telling us that we must be confused because she would never do something like that. There you go folks. We’ve been declared confused by a confused old lady.

Good Day, Bad Day

Sometimes I have really good days at work and sometimes I have really bad days. But sometimes, I can’t decide so I have to make a list, weigh the pros and cons and then fall asleep on a public transit vehicle on my way home. A couple of days ago, I had that kind of a day. I figured I’ll write that list down today and see what averages out for an unremarkable day.

I got to work on time to get a detailed report so I was feeling extra confident when doctors randomly decided to walk into patients’ rooms to ask questions.

A man was transferred from the ER onto our floor and was screaming lovely things towards the transport folk and nurses like, ‘fuck off you cocksuckers’, ‘I’ll fucking kill you cocksuckers with my bare hands’, ‘don’t fucking touch me’ and ‘AHHHHHHHHHHH’.

I did what could be considered the most perfect job at starting an IV.

It was on the screaming delirious patient who pulled it out 5 minutes later.

A patient’s wife gave me the most delicious almond and cashew chocolates for washing his face, changing his damp sodden sheets and putting Vaseline in his nose so his NG tube wouldn’t irritate him so much.

Another patient who was wandering and confused ate almost all of them.

The aforementioned patient’s son-in-law was devastatingly handsome.

He was happily married and had two kids. Oh and something with national nursing regulations…

We only had two new admissions.

Both of their histories were inaccurate at best because 45 minutes later, neither one of them could remember their names.

A guy at work was playing the best hip-hop and R&B songs to keep us all going.

A patient’s mother complained that we were playing too much ‘sex music’ at the nursing station. I kid you not.

I got to leave half an hour early and had enough time to pee before commuting back home,

I missed the train home because I decided to get frozen yogurt.

Surrounded by Incompetence

Lately, I’ve been noticing that there are some people who don’t do their jobs properly. By itself that statement really is not an earth shattering observation but it really irritates and scares me when NURSES don’t do their jobs properly. Several days ago, I was working (yet another) night shift when I noticed a little old lady hunched over in a commode chair beside her bed. I immediately had a funny feeling about her even though she was not my patient and went to take a look at her. She was blue. As in, ‘I can’t breathe so I’m about to give up and die’ blue. I stuck the nasal prongs on, blasted the oxygen to 100%, pressed the call button, grabbed a vital sign machine and started taking her vitals which were 36.4-117-8-67%-165/94. Not Good. She was going into respiratory arrest and she was left alone. I had another nurse come to help me out with this patient and she told me to find out who this lady’s nurse is for the night and to call the critical care team immediately for a desating possible resp arrest. I called the team first and then informed the patient’s nurse who became quite irate with me. She told me that since I’m not licensed yet, I really shouldn’t tell her how to take care of her patients. Fair enough. But this lady is BLUE! When the critical care team arrived, this nurse peaked in for a minute to tell them the woman’s age and admitting diagnosis – information that was right in front of the team leader. She then proceeded to pour out drugs and to help someone else to the bathroom leaving the critical care team alone. I could not believe that this was happening! I realize I don’t have a license but I do know the basics of prioritization – not breathing takes priority over brushing teeth before bed! In the end, this woman was transferred to the ICU for closer monitoring and she recovered.

Yet another example of incompetence in the work place happened just two nights ago. I had to leave my night shift early because I had to go to school for an early morning exam that didn’t count for any marks. That’s just another rant. When I woke up from my slightly extended nap, I gathered up the sheets to throw them back in the laundry when I saw another nurse wheeling supplies over to the unit to help out with the 5 o’clock train. I said good morning to her and she said the same to me. That’s when I looked into the room that BOTH of us were passing by and saw my new admission from the night lying on the floor in a puddle of blood and urine moaning in pain. My reaction was to drop the pile of sheets I was carrying and rush to this man’s help. This nurse’s response was to ignore it so completely that I thought I missed something. She just left on her merry way. Again, I’m not licensed, but finding an elderly man in a pool of blood is something to be concerned about. He was admitted for falls due to seizures so before I went to take my break, I told him to ring the call bell if he wanted to get out of bed so someone would be with him and he could avoid breaking his ass. Being a sweet old guy that he was, he decided to not cause us trouble for a mere bathroom trip so he didn’t use the bell and he was ambulating by himself. Of course he fell and ended up with a scalp lac nearly 5 inches in length and while waiting on the floor for help, he wet himself. I wish I could have stayed with him because he really was a sweet old guy but unfortunately, all I had time to do was to help him back to bed, apply pressure to his wound and call the ER doc for stitches. I shudder to think what would have happened if I wasn’t there to see him because the oblivious nurse probably would not have thought to call someone over for help.

So the lesson of this post: no matter what you do, do it properly. If you’re a nurse, please don’t leave your patients blue and bleeding. That’s atrocious practice and makes you look like an incompetent idiot. If you don’t know what to do, call for help! Please don’t let your ego get in the way of someone’s health.

Tuesday, July 29, 2008

One of those days...

Even though I’ve been learning some interesting stuff and becoming a bit more independent in my unit, I haven’t been blogging much. Why? Two reasons: night shifts that destroy my sense of time completely and idiotic papers assigned by my idiotic school. I was informed that the point of consolidation was to gain clinical skills, not to churn out steady streams of bullshit. As it stands, I’ll be working three night shifts in a row this week and then right after the last one I’ll be going to my idiotic school to hand in a paper and do a mock licensing exam. Tell me how this works please – all summer we’ve been working ungodly hours for FREE while writing papers that will have no bearing on our lives and then expect to study for the licensing exam? I’d really like to have a few words in a dark alley with the no talent ass clowns who thought that the current set-up would be a good idea.

In any case, I can’t not write a little bit about hospital life so I’ll end this rant with a little anecdote. The nurses on our floor were recently told by the manager that we are no longer allowed to call computer on wheels ‘cows’. A big boned (read morbidly obese) patient complained that the staff were making fun of her when we said, “go get the cow to bed 04B”.

People are morons.

Thursday, July 3, 2008

Fight Club

Lately, I’m finding that I’ve been spacing out a lot. During my last shift, I forgot to hook up the IV into the patient after programming everything perfectly! After that, I forgot to do my 1700 meds for two of my patients. Maybe its exhaustion, or maybe its boredom but I find that I’m not focusing as well on my day to day routines. But boy oh boy did my attention span ever increase when I had to deal with David, an 87 year old with mild dementia.

He has had an operation on his knee and a pressure ulcer on his foot, so walking is extremely difficult for him. Yet, he insists on walking. So what are we to do? We bring him on over to the nurses’ station in a geri-chair to keep a close eye on him. Usually he just talks to himself, but on this day, he was particularly agitated. He tore apart his pillow so he was surrounded by polyester fluff for a while and then he tried to undo his gown by any means possible, including chewing on it.

While my teacher and I were busy with other patients and transcribing doctors’ orders, David soiled himself and was trying to remove his clothes to try to clean himself up. Now, before I go any further into this story, I should mention that David is MRSA positive and he is suspected to be positive for C. diff. Naturally, we do not want him to try to clean himself up in front of everyone and then touch other surfaces with dirty hands. I should also mention that the smell around the nursing station was so pungent and palpable that it felt like a physical blow to our olfaction.

He needed to be taken back into his room as quickly as possible to prevent any further olfactory trauma. When I started to wheel him back into his room, David started to whip at the air with his gown and a flat sheet yelling, “YEE HAW” and “Giddy up horsey”. Being the professional I am, I started to laugh until my sides hurt and tears started to flow freely! Truly, it was quite funny. However, the laughter stopped when we got to his room because his mood immediately changed. He saw his neighbor’s family visiting and thought that there were intruders in his room. David started yelling incoherently and held on for dear life to the doorway frame so I couldn’t push him into his room. Slowly, but surely, patients and their families started to peek out their doors to witness the spectacle that was about to unfold.

David is a big man. He weighs at least 200 lbs and he is about 6’2. The brakes on his chair weren’t working too well. This meant that I had to hold onto the chair with all of my strength as David tried to get away. For once in my life, I was extremely happy that I am not built like a frail sprite! Nonetheless, I managed to calm him down enough that he stopped struggling – which is when I quickly wheeled him into his room. I know that’s very deceptive but at the time I thought that this was the best way to prevent him from trying to get away and to stop the other patients gawking at us. I drew the curtain around his bed and reassured him that he was in his own room and that the ‘intruders’ were in their part of the room. I learned something then – placing your hand on a patient’s chest while kneeling down to be at their eye level and saying “stop” gently usually works for a little while.

My teacher then came into the room and wheeled over a commode chair for him. Like I said, he is a big man and extremely unsteady on his feet. As a result, he was very difficult to transfer, but we managed to wheel him over to the toilet. He finished his business and but when he stood up to go wash his hands, he nearly fell over and that would have been BAD… calamitous bad. I panicked and called the emergency alarm and yelled out for anyone else to come and help me. I think the alarm and my cries for help frightened David so he took a swing at me – and got me in the stomach. That literally knocked the wind out of me. I now have an angry looking purple bruise right in the middle of my stomach. Luckily my teacher was got there to hold down his wrists and managed to get him into the chair. Not so luckily, he swung his fist again and socked her one in the jaw. Now we were both momentarily incapacitated and David tried to walk. This is where professional nursing practice falls apart. I knew that if he stood he would fall and split his head open. I got up and almost tackled him back down into his chair and tied a restraint around him, which of course infuriated him. David started to swing his fists again and despite my best intentions, he got me in the ribs this time. “David! Don’t you dare hit us! You’re hurting us”, I told him. “You guys are trying to kill me” was his emphatic response along with another attempt to punch me. ‘That’s enough of this bullshit’, I thought. I went out of the room and drew up 3 ml of Haldol while my teacher called a code white. I knew that it was a prn med for him, but I wasn’t sure of the dosage. Nonetheless, I stuck that needle in good. Coincidently, that was the first time I’ve ever given an IM injection. What a way to start! A third nurse and two security guards finally arrived to help us get him dressed and back into his chair. 3 ml of Haldol and he still didn’t calm down for 20 minutes! When we finally managed to wheel him back to the nursing station, he was sleeping every so gently. He actually looked quite sweet.

Despite getting a good story out of this incident, I don’t think we handled it well at all. Here was a man who has dementia and felt extremely threatened by strangers descending down on him so he tried to defend himself. We became equally defensive and our response was to chemically restrain him and then call more strangers down to help us out. When I rechecked his MAR, his Haldol dosage was only 1 ml – I gave him three times the ordered dose. Of course we had to fill out an incident report, but I did not feel particularly proud at the thought of having to explain this to his family. Hopefully, the next time I see David, he’ll be feeling a lot better and I won’t have to be a part of a code white. For now though I will be nursing my own bruises.

Wednesday, July 2, 2008

Shifts Happen

Ah night shifts. Gotta love ‘em. I’ve come to like night shifts because usually they are a lot more peaceful than day shifts. I also happen to like the fact that call bells don’t go off as frequently, giving me more time to document, review charts and getting to know the unit. But night shifts also mean that I have to get used to dealing with some bizarre situations. A typical night shift goes something like this:

1900
I get to the hospital and my first stop is the friendly Tim’s, where the server has my order prepared as soon as he sees me – large black with two creams and two splendas on the side. The urge to get a honey cruller at times is quite strong but I have to begrudgingly walk away. The thought of seeing myself as a patient scares me! I’d much rather be the one who starts the IVs, not receives them.

1910
Make my way up five flights of stairs (again, refer to comments about not wanting to be a patient) and get report from the day shift. At this time, I’m usually praying to any deity that comes to mind to give me a set of patients that won’t ring the call bell.

1930 – 2200
After getting report, I make my around the rooms introducing myself and doing initial assessments. I’m finding that lately I’ve been doing more mental status assessments than before. One patient told me to “fetch some tiger shrimps waitress”. He was on strict orders to not eat anything for 12 hours to prepare him for tests. When I told him this, he looked at me with puppy dog eyes and asked me, “why can’t I get some goddamned tiger shrimps?” I have to restrain myself from asking non-patients questions like, “Are you in any pain?”, “Did you have a bowel movement today?” and “Can I take a look at your feet?”

Oh but wait, what’s this? “Maha”, my preceptor calls out. “New order for Mr. K. We’re giving a unit of blood stat. Get the paperwork ready and lets take a trip down to the blood bank”. So I rush through my assessments, run down to the blood bank, get a new unit of blood, run back up, take baseline vitals and start to hang the blood. That is until my preceptor gently, but firmly reminds me that I need the Y-type tubing a 500 ml bag of normal saline. D’Oh! Off I go to the clean room, get tubing and saline, start to do baseline vitals but remember that they’re already done and hang up the new unit. Since I have to check this patient’s vital signs q5mins, I run out of the room to prepare a heparin injection for the patient next door. Back to do vitals – looking good! Run out for another 5 minutes, give the heparin injection, sign the sheet and run back to do more vitals. Now I have 15 minutes until the next set of vitals. ‘Great!’ I think. ‘Just enough time to get two sets of meds done!’ Finally, his transfusion is finished and he looks a lot better. Goody goody gum drops, I can sit now!

2230-0000
Documenting time – lots and lots of documenting. When I first started, I thought, ‘this isn’t too bad – 10 minutes and I’m done’. What a chump I’ve been. When I first started, I only documented 2 people’s vital signs. Going through all of the assessments for 10 patients gets very tedious, very quickly. Truly, it becomes a struggle to not check email, facebook or another equally insidious site.

0000-0100
What’s this? Peace? Quiet? Calmness throughout the ward? Can’t be. I’m nervous. Better do the first set of rounds to make sure patients are still in bed and alive. This sounds morbid and it is. I hate standing over patients, watching them breathe a full cycle with a flashlight pointed at them. First set of rounds go great, and since (for once), I’ve finished my documenting, I can get started on other jobs. We all start checking various machines to make sure they are working, medication carts are restocked, narcotic counts are done and new narcotic records for the next day are made.

0130-0330.
Its first break, which means that I can now sleep, while the second break staff takes over the patient load. I would have preferred second break (from 0330-0530) because when I wake up, there is only 2 more hours to go! But I’ll take what I can get.

0345-0400
I feel groggy and slightly nauseous from having slept so little and needing so much more sleep. Nevertheless, I grab some fruit and start another round. This time I find a man trying to climb his bedside curtain. “Sir, what in God’s name are you doing?” He looks rather like a feral animal on the hunt hanging from his curtain while I point the flashlight at him. “Get back into bed!” He obliges and I thank my lucky stars that he didn’t pursue the matter further. When I come back to check up on him, I find him sitting up in his bed, shaving himself. In the dark. With a piece of paper. I thought I was on a cardiology floor, not a psych floor. My eyes are on fire so I go back to the nursing station to sit and pray that no one uses the call bell.

0400-0530
The guy who got a blood transfusion is not breathing well. I can hear coarse crackles from the doorway to his bed. Not good. My first thought was that he was having a reaction to the blood but when I went to take a look at him and went to take his vital signs, he was not displaying any telling symptoms of a transfusion reaction. He did not have a fever, chills, pain, fainting or dizziness, or bloody urine (those were the ones I remembered). Also, wouldn’t these symptoms start showing almost immediately after the transfusion? He finished receiving blood a few hours earlier. Coarse crackles were the only new development. I called my teacher over who pointed to the IV pole. “Notice anything there?” she asked. My blank bleary eyed look said it all. “He received 2 units of blood along with 500ml of normal saline all within the span of a few hours. Potential fluid overload perhaps?” I responded to her with a blank bleary eyed look once again before garbling something along the lines of “lots of watery stuff in lungs means Lasix make man feel better”. I’m so smooth. When we went to check his MAR, it turned out that there was no order for Lasix! That meant that we had to get a doctor, any doctor, to give an order for 20 mg of IV Lasix. Calling doctors and begging for obvious orders is one way to wake up. My teacher was visibly annoyed and told me that usually 20 mg of Lasix is a standard order with a blood transfusion. At least we got the order and the patient’s breathing finally sounded normal. Job well done!

0530-0730
A burst of activity and I have to stay awake! We start checking patients to make sure they’re still in bed and if they need to be cleaned up. The nurses on my floor call this the five o clock train because we all line up, take adjacent rooms and start cleaning patients up (if they need to be cleaned). Since its almost end of shift, foleys need to be emptied, I&Os need to be documented, CHF patients need to be weighed, 0600 meds need to be given out and report for the oncoming shift needs to be prepared. I feel myself getting increasingly restless as the clock ticks closer to 0730 because the only thing on my mind is a shower and my soft lavender and vanilla scented bed (courtesy of Downy). But when its finally quitting time, I run out to the train station where I’m greeted by fabulously well dressed people while I look like a smelly homeless person who stumbled across a pair of scrubs. It doesn’t matter because my day (err night) is DONE!

Tuesday, June 24, 2008

Cops and Robbers

I went in for a day shift expecting a familiar patient load consisting of situations such as cp n/y dx’d (chest pain not yet diagnosed – I stared at that for a good 25 minutes before I gave up and asked what that meant), various dysrhythmias and diabetes. Well, I (along with my teacher) got assigned to be the nurse for a 35 year old man with a lackluster medical history but a remarkably colourful personal history. He was a prisoner and was jailed for a variety of offenses such as theft, drug possession and trafficking and assault. He was found to be confused and breathing very rapidly (Kussmaul respirations). He was later diagnosed with hyperglycemia. Of course, being a student, I was not allowed to go into his room alone, despite him being handcuffed, shackled and surrounded by 4 armed guards. Since interacting with prisoners is quite out of my range of experiences, I decided that I should go into the room with carte blanche. I don’t know how well that served me, but when my teacher and I went into his room to introduce ourselves as his nurses, we were greeted by a barrage of profanities and lewd remarks, the tamer of which included, “F@#k off b^&#$*s” and “I’ll kill you if you touch me with that thing [the blood glucose testers]”. A wonderful start to a wonderful day. As the day wore on, his comments became increasingly obscene until halfway through the shift, when he became a lot quieter and decided to let us do our work in peace. At one time, he even asked about an IV solution he was receiving and merely nodded when we explained its function.

Sadly, his tranquility did not last for the rest of the shift. Towards the end of the shift, my teacher allowed me to test his blood sugar levels. When I approached him and explained what I was going to do, he nodded in agreement and let me proceed. However, when I was about to lance his finger, he jumped up at me (he was still cuffed to the bed) and menacingly said, “Boo! Scared ya didn’t I sweetness?” Of course he did. I jumped back, dropped the lance, testing strips and created a mess that I did not want to clean up while his jeering laughter provided the soundtrack to the moment. I ended up leaving the mess because I did not want to be in that room any longer. I didn’t get a blood sugar reading

Having done a short stint in a mental health facility, I thought I would be better prepared work with ‘shady’ characters, but this man made me recoil. I did not feel sorry for him at all. He was convicted of and found guilty of serious crimes. He deserved to be in jail. And yet, I could not stop thinking about what being hospitalized meant to him. Did he see his room as a temporary respite from his cell? Or was this the same prison with different but weaker wardens? Is that why he felt comfortable trying to scare us? Did hyperglycemia and the ensuing diagnosis of type II diabetes really matter to him? Most of all, I wanted to know if he was sorry for the crimes he committed and if not, then how did he rationalize and justify his choices? I wanted to know the answers to these questions, but I did not want to be the one to extract that information from him. I wanted him to forget that I existed because knowing that I am known by someone who is comfortable with panning out brutal violence for slight provocations scares me. This is one abyss that I am happy to leave far behind

Friday, June 20, 2008

First Impressions

First impressions are powerful, but they’re not always accurate. When I first started my training, I was extremely angry at not only being denied the emergency department (my first choice), but being placed at yet another community hospital. I wanted to be in a downtown hospital so I could get away from the suburbs. The thought of spending four months in another ‘burb became too much to bear. But placements happens so I begrudgingly gathered my belongings and went of to start.

While I can’t say I love my placement (because commuting there is a complete pain in the gluteal area), I have been learning a lot (and not the clich├ęd kind of learning either). My first day after orientation began with meeting a sweet old lady who ripped two IVs out of her arms. Upon seeing her hands, gown and the floor soaked with blood, I let out a small scream (think Homer Simpson-esq), grabbed cotton wipes from the counter and applied pressure to those wounds like no-body’s business. Later on, my preceptor complimented my ‘quick-thinking’ and proceeded to clean up the mess. I learned two things that day; 1) if a sweet old lady pulls out her IV lines, the next step after applying pressure and panicking is to flush the line out with normal saline and lock it up to retain positive pressure and 2) getting blood stains of shoes should be done as quickly as possible.

Yet another patient who made me temporarily forget my ‘burb induced misery was an Indian gentleman who is extremely hard of hearing, named Mr. S. Mr. S is a very demanding patient because he did not follow the rules of the hospital, which according to CCC (that’s client centered care for you lucky enough not to have it shoved down your throats) philosophy is perfectly acceptable. In fact, as nurses, we’re supposed to honor the client’s wishes. But not 45 minutes before shift change. Along with being nearly deaf, he has septic arthritis, which means he can’t ambulate without at least two people helping him. Describing the sequence of events in a chronological order is the best way to relay the sense of urgency and despair that I felt while taking care of Mr. S.

1845: 45 minutes before shift change. He decides to start shouting at around. We (being me, my preceptor and another student nurse) decide to indulge his crazy plan because our charting and 1800 meds are done. Wrong choice. Mr. S. takes 10 minutes to decide on the water temperature alone – and then soils himself.

1900: ½ hour before shift change. Mr. S. refuses to let housecleaning come into the shower to clean up the mess. The Eastern European lady comes in, takes a quick look and aptly declared, “that’s very stinky poo”. Meanwhile, I vomited up my 0500 breakfast. The other student nurse then rubs my back and asks if I’m pregnant!!! No, not pregnant. Merely revolted. Following my ‘pregnant’ pause, Mr. S. spots his son outside the shower (because he was called by my teacher to try to calm him down) and he starts to shout, “YOU BETRAY ME! MY OWN FLESH AND BLOOD BETRAY ME!” I believe sheer exhaustion and revulsion combined with residual nausea made me burst out laughing in the most inappropriate manner. Luckily he was hard of hearing and so my shameless laughter failed to further enflame his anger.

1915: 15 minutes before shift change. Mr. S. is smiling like a smug child who got his mother to buy him a candy bar after she refused to do so. “SISTER” he shouts. “Come, give me a warm blanket, a cup of coffee and something sweet to eat”. Did I mention he’s a very poorly controlled diabetic? His morning CBG reading topped of at 17 mmol/L. Not good.

1925: 5 minutes before shift change. “SISTER?”, he shouts once again. “Where the hell is my bloody coffee? SISTER?”. At this time, I have to remind him that he’s not getting coffee or anything sweet because we don’t want him to die in the middle of the night. “Mr. S. you can’t have something sweet right now because your blood sugars are completely out of control. And it’s almost time for bed. He replies, “you’re absolutely bloody useless. This entire hospital is bloody useless. Go. And don’t come back with something sweet for me. Some mithai (an Indian sweet) would be good”.

1930: Shift change. “Good night Mr. S”, To which he cordially replies, “You’re all bloody useless bandars (monkeys)!! Never come back in my room!”
“You sleep well and dream sweet dreams sir”.

1935: 5 minutes after shift change. I started to virox the blood and crap (literally) out of my shoes. “Frikkin crazies” I hear the other student nurse mutter to himself. “Hey, pass me another virox would ya?”

1945: We gave a very late report to the night nurses much to all of our chagrin.

2000: I never thought I’d be so happy to see my dad and his clunky old Nissan. “Hop to it popsie! I gotta shower and scour myself stat!” As usual, the day ended with a member of my family giving me weird looks while deciding if putting me in a psych ward would be a good choice or not.

Reflecting (yes, my school's favourite word) back on the situation, I wonder, did I honor the patient’s wishes? Probably not. Was I patriarchal in my treatment towards him? More than likely, I was. Did I practice CCC? Absolutely not. I practiced MCC (Maha Centered Care), which involved pursuing nothing more than a hot shower and my bed because my feet, knees, hips and back were screaming for rest. Could I have handled the situation with something better than snide remarks, vomiting and laughter? Probably. Will I try to handle a similar situation with more tact in the future? Of course, but it gets very difficult when a patient doesn’t respect your time.

So what do I think about my placement? I still say that it certainly is not as exciting as an emerg department might be, but the ‘burbs still have the potential to leave one shaking their head at the end of the day. My first impression: You betray me!

Sunday, May 18, 2008

About Me or How I Ended Up in Nursing School

Not so long ago, I was perched on a bench in a lab surrounded by a shelf of jars containing live locusts. I hate locusts. In fact, I’m not a fan of bugs in general. But there I was, suspended between paralyzing inaction and an overwhelming desire to stuff my lab coat in the fume hood before walking out and never looking back. I have zero confrontational skills so while I muttered a string of profanities, I walked over to the locust jars, closed my eyes, grabbed an unlucky bug, pinned him onto a plate and then cut out its gut. Not a high point in my life. Just then, my supervisor came in to encourage my work by telling me that I should consider applying for a master’s degree in biology with a focus on insect physiology. That was it. I decided that there has to be more to life than torturing insects (which I despised – the torture and the insect part) and politely told my supervisor that I will not be returning in the summer due to personal reasons (such as disgust and apathy towards my work).

That felt great. For about 10 minutes. And then I panicked. “What the hell will I do now?” I wondered (aloud on a subway). “I can’t spend the rest of my life as a poorly paid lab rat... I like pretty things too much. And a Master’s in biology? I’d rather give up cake”(again, muttered out loud in a subway). While I was contemplating the direction of my life and enjoying the increasing amount of empty seats near me, I saw some people get in the subway wearing scrubs. This story would be tied up in a neat little package if I said that that was the moment I decided to enrol in nursing school. But that wasn’t the case. I was lulled into a deep sleep by my food coma (a non-medical term coined by my friend, referring to a sleepy feeling after eating a heavy meal).

Over the next few months, I started to panic about what I would do with a crummy ol’ BSc in biology and started to consider my options. Luckily, I was also volunteering on a medical-surgical floor in a hospital and for some strange reason, I thought, ‘Hell, I could be a nurse. I like blood and guts, I like people, lots of folk in my family are in health care, I’ve always wanted to be in health care, and going to work in pyjamas is just the icing on the cake… umm… cake)’.

Shortly after hanging up a $30,000 piece of paper (my degree) on the wall, I got a letter saying that I had been accepted into nursing school. Awesome! I prepared for my new career by renting out the first 6 seasons of ER (fine, George Clooney was the real reason… gimme a break) and started becoming a much bigger nuisance to the nurses on the unit in which I was volunteering.

Suffice it to say that nursing school was nothing like I imagined it. I thought we would start learning gruesome and bloody stuff right away. Alas, that was not the case. We theorized and conceptualized (until our eyes bled) before we were allowed to touch patients. During the course of the nursing program, I was placed in units such as maternal/child care, long term care, neurosurgery (not nearly as impressive as it sounds), paediatrics, mental health and the community. And now, it’s finally (FINALLY) time to do the consolidation (an intense period of in-hospital or community training before graduation).

Since the consolidation period is probably the most exciting time of nursing school, I figured this is the ideal time to start a blog featuring heart-warming, gut-wrenching and sometimes just plain old twisted anecdotes. I’ve also been told that I have a keen sense of twisted anger when I’m sleep deprived and that it should be shared with others. So for my adoring public (consisting of about 3 people), here it is; Maha’s blog! Enjoy!