Sunday, January 24, 2010

When You're Afraid of Blood...

I recently had a patient brought to me from a nursing home for hip pain. The patient was quite heavy and because of the hip pain, which turned out to be broken, he was on the immobile side of mobility. Repositioning him was ideally a four person job but during a busy as hell day shift, I had to make do with only one nurse and some creative stretcher maneuvering. However, his son came in during the middle of the day to help out. This guy was amazing. He was a freaking bodybuilder (!!!!!) so he was a little stronger than me. He helped out with repositioning, changing, feeding and he was a very calming presence for his dad. So it came as a little surprise when he flat out refused to hold down his dad’s arm when I needed to resite an IV that went bad. “Uhh umm uhhh okay?” was my reply to his refusal. “Miss I’m like really afraid of blood! It’s just… so… so… RED!” I respect that so I told him not to worry as I went to grab another nurse to help me. I asked him if he wanted to stand outside the room. He stepped outside, but guilt and filial duty prompted him to come back into the room to help out just as his dad’s vein was cannulated with some blood escaping. I saw his face turn ashen and then he hit the ground with a loud thud. For a few brief seconds everyone was stunned into silence as we stared at the 6”5’ bodybuilder slumped on the ground. Luckily the nurse who was helping me had more sense than I did and rushed over to the son while I finished up with his dad’s IV. Ignoring a few bruises, the son was unharmed. “I told you I was afraid of blood miss”.

Monday, January 18, 2010

In the Same Room

Several shifts ago, I was assigned to an area with five rooms. In one of the rooms was a homeless man who was being treated for cellulitis and hyperglycemia. He was eventually discharged to a community care centre where home care nurses would take over. After the room was scrubbed clean, another patient was brought into the room. The second patient was a fairly well known celebrity. I thought that it was remarkable that two people with completely opposite socioeconomic backgrounds were treated in the same hospital, in the same room by the same team of doctors and nurses. The Canadian health care systems may have its problems, but it was nice to see it actually working as intended.

Friday, January 15, 2010

Critical Care

Today I felt heartbroken while listening to the news about Haiti on my break. It seems so remarkably unfair that the poorest nation in the western hemisphere must bear the brunt of such a horrible disaster. Please bloggers, donate generously to charities because the best thing we can do for now for the people of Haiti is to give money to reputable international aid organizations. Check out these links for more information.

The Red Cross –
Oxfam International –
Doctors Without Borders –
World Vision –

Also read Dr. D’s more eloquently written appeal to donate to Haiti and his time spent working their prior to becoming a doctor.

Monday, January 11, 2010

Top 10 Mortifying Ways to Die

A few days ago, I was wrapped up in my blankets trying to ward off the -27C wind chills. I wanted to socialize but the prospect of freezing my ass off (in a very literal way) prevented me from leaving the confines of my down blanketed couch. Compromising between complete anti-social behaviour and face-to-face interaction, I started to catch up with another fellow nurse on MSN. When two nurses who are sleep deprived and lean towards the odd side of normal, we come up with a list of top ten ways to die. The hilarity was far too much to keep to myself, so without any further ado, here is our list of the top 10 mortifying ways to die.

10. Having a vasovagal episode while taking a huge dump after being constipated for a week.

9. Getting hit by a car while streaking on the highway.

8. Electrocuting oneself with a vibrator.

7. Accidentally asphyxiating/hanging oneself while trying to achieve sexual gratification.

6. Hitting your head on the ceiling IV fluid hanger in the middle of a code.

5. Choking on the finish tape at the end of a marathon.

4. Getting hit by the Oscar Meyer car – in front of the nutritionist’s office.

3. Re-enacting a stunt from “Jackass”.

2. Being eaten by a bulimic wolf and then being barfed back out.

1. Falling headfirst into a bedpan full of C.diff and aspirating on it.

Got any other embarrassing ways to die?

Saturday, January 9, 2010

Dear Residents

We have been working together for quite some time now and I hope you know that I’m your friend. I don’t mean that in a facetious or sarcastic way at all. I truly am your friend. I value your learning very much because one day you little doclings are going to grow up to treat me as well as my loved ones who are hovering around their 60s and beyond. I realize that despite all the orientations you will get from your seniors and attendings, navigating a unit, its protocols and its culture can be frustrating. Many of you turn to nurses to guide you through the noisy maze and while I can’t speak for every nurse, many of us are more than happy to help you through the process. Us nurses are also familiar with the attendings’ mood (swings) and their teaching styles so if for some reason you find that the head honcho is bitching at you for something mundane, we can probably guide you towards a safe exit. So in return I would greatly appreciate if you could please keep the following guidelines in mind:

1) Don’t page a nurse overhead stat to a patient’s room to deliver blankets and clean diapers. Especially if the nurse is another room doing a delicate procedure – like say, CPR.

2) Don’t order an esoteric combination of medications past the hour when the pharmacy closes down and we’re down to floor stock, especially when something simple would suffice. If you want to know whether or not a med is stocked, just ask!

3) If you sign up to see a patient, please ensure that you actually do see them. Patients tend to get irritated when they come to a hospital and are not assessed by a physician. They then take it out on the nurses, which makes everyone unhappy.

4) If a nurse is telling you that a licensed physician needs to administer a medication, writing “nurse may give ____” on the chart is not going to cut it. We all have our licenses to protect and we all like getting paid. It helps a lot with groceries and rent.

5) While we’re on the subject of writing appropriate orders, please do not write, “nurse may administer available narcotics until pain manageable”. I’m flattered that you value the nurses’ judgment so highly but narcotics are highly controlled substances which need clear orders to dispense. Also, see comment above about groceries and rent.

6) And yet another guideline for appropriate orders. If you’re in an area of the department in which patients are only brought into rooms for assessment, it is not appropriate to write, “patient may sleep in room”. If myself or another nurse actually followed that order, we would have our asses kicked from here to Australia and back with a steel toed boot for slowing down patient flow.

7) Please leave charts as you find them. As much as some of us might have liked scavenger hunts back in grade school, somehow the joy of hunting down a chart is just not the same thing.

8) If you’re in a patient’s room (especially one that is an isolation room), please do not ungown, wander the department and ask the nurse to obtain a set of vitals on the isolated patient. Patients who are isolated have their own fully stocked vital sign machines inside the room.

9) If you freeze up during your first code don’t feel bad. There are a lot of experienced nurses and doctors in the room. I guarantee everyone can sympathize. The sympathty ends however, if you start finger pointing and blaming.

10) Please and thank you always help when talking to anyone and everyone.

Follow these guidelines in any department on any rotation and I guarantee you’ll have a good (or at the very least, tolerable) relationship with the rest of the staff. I hope you enjoy your emergency rotation and if Crazy Carl is insisting that the key to survival lies in dismantling the IV pump, please order Haldol stat.

Your friend,


Sunday, January 3, 2010

Ten Years

I have always been told that in order to go forward, one must examine the past. Inspired by the beautiful post over at Hope Dies Last, I thought that I too would begin the new year by reflecting on how I’ve changed over the past 10 years.

I rang in 2000 huddled with my friends around Lake Ontario in frigid weather watching fireworks and waiting for the big y2K shut down. I was on top of the world and free from every restriction because my family was in another country and I was almost finished with high school. I was whoever I wanted to be. I didn’t belong to anyone. That year I partied way too hard, spent too many nights out late and devoured every piece of literature I could get my hands on. Afterall, I would be a Pulitzer prize winning writer. I was half-heartedly trying to catch the eye of that special someone but wasn’t particularly disappointed when I lost interest after a while. I still kept partying though.

In 2001 I started my first year of university. I was overwhelmed and excited by all that had to be learned. I made lots of new friends, lost a lot of old ones, then couldn’t keep in touch with the new ones. Being overwhelmed by my parents’ concern for my future, I spent half the year locked up in the library. Unfortunately, it was the wrong half of the year I spent in the library. I completely fucked up my first year.

2002 was the year I had to convince my parents that I was never going to become a doctor. The ‘future’ was amorphous and frightening and I had no intention to discuss my lack of direction with anyone, let alone my father. I also had to convince my mother that I will probably never be the traditional south Asian woman she wanted me to be. I was a product of Canada and I had no ties to back home. I had no idea what I wanted to do or what I wanted to be. I was ready to quit school. I felt extraordinarily lonely. I spent a lot of time crying in the middle of the night.

In many ways 2003 was the spring of this decade. I found my niche in university, I found courses and professors that inspired me. I made friends that saw me through thick and thin. The humidity of the summer slowed time enough to let me focus on what I wanted to with my life. My hopes were high and my expectations higher. And I lived up to them.

I kept fighting with my parents in 2004. It was the last time I saw my grandfather before he passed away. I felt like shit for most of the year. I was working towards a masters degree I had no interest in pursuing. I fervently wished that time would slow down. I wished I picked a better major, a different school, a different life. I felt lost, directionless and purposeless once more. It’s also when I started to give nursing some serious consideration. I also took up a lot of bad habits – I gained a lot of weight.

I was supposed to graduate in 2005. Instead I took up a part time job, dropped a few courses and told my supervisor that I would not be applying to the master’s stream. One of my friends got married. I went to her wedding reception feeling like an immature child. She was my mother’s dream come true. A well educated lady in a beautiful sari on her wedding day who wanted to start her own family. I was happy for her, yet I resented her because she had the wisdom to realize that one’s background is a very large sphere of influence in life. Ties to one’s background and to one’s family are never really neatly severed.

2006 was a year of beginnings and endings. I graduated with my first degree in biology and two social science streams. Did I mention I was a tad indecisive? I said goodbye to some really good friends as they moved abroad and started their own lives. My sister and I spent our summer bitching about the poverty that seems to go hand in hand with being a student yet still managed to have a lot of fun as always. I started the accelerated nursing program. It slowly dawned on me how much responsibility I would have to shoulder. I wanted to quit. I got involved with a not so nice guy.

I didn’t quit nursing school in 2007. I trucked through some horrendous clinical placements. I put up with crappy preceptors. I learned to quickly recognize and bow to the healthcare hierarchy. My dad was convinced that I would change my mind and hand in applications for the master’s in biology program. It never happened. My sister put up with me rambling about drugs, pathophysiology and the cruelty of having to write so many papers. I lost a whole lot of weight – mostly through healthy means but there were some unhappy days that involved starving, a whole lot of caffeine and a few instances of binging and purging. I was strong, I was focused. I was determined. I felt weird when people started to ask how I lost so much weight and how much better I looked. I made incredible friends in nursing school (here’s looking at you G and J).

I graduated from nursing school and got hired in the ER in 2008 on a probationary basis. A part of me couldn’t believe that someone would be stupid enough to hire me right out of school and in an ER of all places. Mostly though, I was elated and incredibly thankful that someone was willing to give me a chance. I was going to be an EMERGENCY NURSE. I felt as if I had finally conquered a step towards truly growing up. Though I was at the bottom of the ladder, patients still looked to me for answers and guidance. I was scared shitless and the magnitude of responsibility felt overwhelming. I started blogging a lot more. My uncle sent me a text in the middle of a shift telling me that my grandfather had died of lymphoma. I spent my lunch crying in the bathroom. To my everlasting regret, I never made the trip back home to see him one last time and tell him how much he meant to me. I wish he could have seen me as a nurse.

I became a full-fledged staff nurse in early 2009. My learning increased exponentially by attending the school of hard (health care) knocks. I put a few extra letters next to my credentials in my CV. I’m amazed at how much I know and overwhelmed by how much I have yet to learn. I started to teach again, albeit as a nurse rather than tutoring kids in science and math. Despite my endless bitching (in this blog and to my wonderful sister), I remained incredibly thankful for having a job in which I can actually make a difference to someone sometime. My parents and I stopped fighting as much – we’re all too old for it now. My circadian rhythm has been effectively degraded into a cacophony of noise.