If Only...

How I wish I could give this out as an info sheet to some people (including docs, other nurses and general pain in the ass know it alls).

http://www.iddxblog.com/2008/05/kevin-warns-you-about-cranio-rectal.html

Must Have Been a Full Moon

The last set of night shifts left me shaking my head at the patients that ended up in the ER.

Exhibit 1: A skinny, wiry 20-something year old man drunk and high was found wandering in subarctic temperatures in a flimsy concert T, hoodie and jeans complete with socks and sandals is brought in by EMS for bizarre behaviour. According to the more stylistically inclined nurses and docs, the sock and sandal sartorial faux pas should have been enough to drag him in for emergency mental health counselling. He was pleasant enough for being drunk and high so after he received the perfunctory saline bolus, he was left alone with a call bell and heated blankets. Approximately 3 hours later, he appears at the main nursing station (at which LOLs are inquiring about their family members) completely in the nude, with an erection that’s covered by a roll of toilet paper. He gleefully asks everyone (loudly) if anyone needs toilet paper. He was promptly escorted away by security while his nurse practically taped gowns on him. Unprofessionally loud laughter ensued.

Exhibit 2: A 40-something man found by EMS sleeping on a park bench with blood oozing out from his arm. He too was drunk but unlike exhibit 1, he was NOT pleasant in the least. He was screaming, swearing and flinging used urinals at security and anyone unfortunate enough to cross his line of vision. After managing to punch a nurse in her thigh, he was put in four-point restraints and got an IV. I pushed in haldol and lorazepam so fast that had he been sober, it would have made his head spin. Nine hours later he sounded like a refined gentleman politely asking me for a glass of water and some ibuprofen whenever I get the chance!

Exhibit 3: Princess Diana shows up again, this time insisting that ‘she’ didn’t assault another man in the shelter she’s staying at. She was brought in by the local police and demanded that those ‘brutes’ at her side be replaced by her royal guards. I was amazed that her delusions for the most part were internally consistent. When she started to attack us after she got a line put in, she too received some haldol. Before finishing my shift, I brought her juice and sandwich and curtsied to her highness. She seemed extraordinarily thrilled with me, which of course made me smile. It’s good to join in on the delusion if it keeps the patient happy until shift change. Besides, I love her killer sense of style!

Exhibit 4: LOM acting ‘totally fucking crazy’ according to mother and grandson. Turns out grandpa had a sweet tooth and managed to get his hands on his grandkids’ hash-brownies. I wanted a sample. Never got one.

After all that excitement, I’m looking forward to having a nice, quiet and uneventful night in my own bed!

Minty Fresh?

Today I was the ER gypsy better known as the float nurse. I went all around the ER acting as everyone's extra pair of hands and sending them on break when they looked like they were in severe need of rest and nourishment. For a little while I meandered about aimlessly until I saw a new patient lined up for me – it was a 20-something woman complaining of intense vaginal pain and soreness. I asked the usual questions concerning past gynaecological history, sexual activity and protection methods used. My assessment was fairly benign until she told me that the condom broke so she used Listerine to wash out her vagina. And it wasn't the alcohol free kind either. OUCH! Once I stopped reflexively wincing in sympathy pain, I spent a LOT of time going over plan B and other (much less painful) contraception methods with her. A lot of time.

Stuff Nursing School Forgot to Teach

There are a few nursing students on my floor and they have all figured out that I'm fairly new staff so they have taken to flocking to me for advice on how to make the transition from student nurse to staff nurse. Lacking the vocabulary to eloquently express both my rage and frustration at the many hours wasted learning about theories that I haven't used and classes on bed making, I've decided that I'm going to print out Glee's list and share it with them while peppering it with my own anecdotes. Thanks Glee for the wonderful 'teaching tool'

Much Ado About No Pooping

Recently I got assigned to a patient with a fairly extensive bowel history who hadn't had a bowel movement in a week along with nausea and vomiting. Long blog post short, he eventually had a NG tube put in and was referred to surgery for a possible obstruction. Somewhere at around 0630 (while the results of his CT and X-ray were being processed) he rang the call bell and asked me if I could temporarily unhook from suction so he could go to the bathroom. I proceeded to do just that while his wife walked him to the bathroom and I went back to my station trying not to weep with exhaustion. Just as I was getting everything cleaned up for the oncoming shift, his call bell rings again and he tells me that he had a massive BM! He even had the courtesy to take several pictures (all from different angles showing varying levels of detail) all for my viewing pleasure. Lovely. So after spending the entire night taking care of his NG tube, listening to his belly, fiddling with his IVs and getting him prepped for a possible surgery, I felt pretty shady calling surgery to tell them of my patient's anal expulsions. Needless to say, surgery wasn't impressed but then my shift was almost over so I really didn't care any longer. The only thing I'm wondering about now is whether or not he could have another problem that needed surgical intervention but since I didn't work for several days after that shift, I won't be finding that out anytime soon. Time to consult my pathophysiology book – if I can overcome the terrible inertia of my laziness and head down to the basement. Maybe later.

Chicken Scratch

I'm lucky to work with a handful of docs who for the most part are great people, teachers and coworkers. But their writing is God-awful. It hurts my spirit to see orders written in a script that would shame a 5 year old. Getting past irritation, poor penmanship causes delays (because a bunch of nurses are either hunched over a chart trying to decipher the hieroglyphics on this page or looking for the doc to clarify the orders) and can be dangerous (reading the dose wrong, misinterpreting the name of a drug, etc). What kills me is when the docs get ANNOYED at me for asking them to clarify their writing! What a scam! Maybe I'll leave a large note at every nursing station stating, 'WRITE LEGIBLY OR PREPARE TO HAVE YOUR PENS STOLEN'

Violence in the ER

I’ve been mulling over writing this post for quite a while because it has taken me some time to mentally process the events myself. As a new graduate to nursing and especially to the ER, I have been repeatedly told that unfortunately violence is a part of the ER. Just Google the topic and there will be a plethora of links to studies and personal stories. The sight of security guards rushing down a hallway to subdue a violent patient, or seeing several nurses using restraints on old people with dementia to protect themselves against random hits and kicks are now little more than mundane sights. I feel that I’ve also learned to deal with the verbal assault unleashed at me by the mentally ill and/or ignorant bigots. Angry patients who are denied their favourite medications or simply told to leave usually part by threatening to find me after work and giving me what I deserve – I don’t think twice about them any longer mainly because the security guards are amazing people who go above and beyond their duty and actually walk me to the subway station if I ask them. This changed abruptly when I saw one of my patients who previously threatened to find me after work sitting on a subway seat in front of me and looking at my direction though not seeing me. I felt a wave of nausea so intense that I ran out of the train at the next stop where I proceeded to throw up two days worth of gastric contents into a garbage can. I paced the stop wildly and let two trains pass by before I shakily stepped into the next one. Despite the fact that I’m tall and quite strong physically, the knowledge of my vulnerability to violence both inside and outside the ER struck me like a shard of glass. While I haven’t turned into a completely paranoid basket case (yet), I’m much more prone to walking a lot faster than I did before, scanning the subway car for faces that I might recognize and sudden bouts of fierce palpitations when I see a random person sharing an inconsequential detail with a previous patient of mine. Perhaps the toughest lesson that nursing has to offer is that of balance - abandoning myself to either paranoia or recklessness will serve no purpose other than destroying my sanity (which is prone to random lapses in presence). The question that I now struggle with is how do I maintain my vigilance while not caving into complete madness?

My Heart is Damaged

I generally find that at around 0230-0300 brain function starts to decline and I tend to either become progressively more insane or more irritated. I asked some of my coworkers on their thoughts on the subject of the ‘0300’ brain and they generally agreed with me. I found this to be especially true when we got a call from EMS saying that they were bringing us a suspected MI. As we were prepping the room, two of the nurses started to sing Damaged (and quite well) with all of us joining in until we received the patient. Now to find a song that can be related to GI bleeds!

Happy New Year!

Since everyone makes resolutions for new year’s, I too will make one to try to overcome my semi-anti-social behaviour. So here’s mine – stop devouring sweets in a blind gluttonous rage during night shifts! Note that it’s not stop eating sweets altogether because that’s just cruel and unusual punishment for no good reason. I especially have to stay away from the ‘diabetes in a box’ cake that currently is the chocolaty love of my life. I’m already starting to notice an increase in my abdominal girth and I am not impressed with myself. I’m also not willing to exercise more than I do right now because I hate gyms and it’s too effin cold to walk outside for prolonged periods of time. Lastly, I like my current clothes too much to start replacing them with super-sized versions. Wish me luck!