I'll be Back in 2 Weeks...

Because I'm on vaykay :)

Sleep Assessment

The past couple of shifts have been INSANE! Multiple codes every day, transfers to other facilities every other hour, police crawling all over the department all the time and everyone wearing the look of incomprehensible exhaustion. My ER saw a record number of patients this week. To say that it was absolute chaos and insanity would be the understatement of the year. When I finally got home after my last scheduled shift, I could barely walk in a straight line let alone speak coherently. I don’t know how I managed to change out of my clothes and wash up before heading to bed but it happened (I had witnesses).

Just as I settled into a really deep sleep, my sister woke me up in a panic and said that she just got a very sharp and sudden pain in her stomach and she feels like throwing up. Sister hasn’t been sick, hasn’t had any changes in her diet and wasn’t injured. She also never ever EVER gets abdominal pains, nor does she take any meds. I asked her some detailed questions and of course asked about her last normal doody (yes even family members aren’t safe from doody questions if they bring up abdo issues) and if she had any urinary symptoms. She said no to everything. Since I was too lazy to get out of bed, I asked her to gently palpate around her abdomen and tell me if any part hurts or is relieved by palpating. She told me that everything was normal. Not being able to think of anything else, I told her to take a gravol, go back to bed and if the pain worsens, wake me up. Naturally, she fell asleep.

The next morning, she told me that her stomach was still hurting and asked if she should go to our family doctor. I was at a complete loss. “When has your stomach been hurting since?”

“Since last night loser!”

Baffled by her annoyance, I shot back, “Well how the eff was I supposed to know that?”

“Dude wtf is wrong with you? We had this conversation at 3 this morning. You told me that if my stomach was still hurting, I should go to the doctor”.

At this point, I was completely baffled. “Alright imma hold you up a minute. What exactly did we talk about and what did I say?”

Now it was sister’s turn to be lost. “You don’t remember?” She then repeated everything I had told her up to and including the part about me telling her that if I didn’t sleep at that moment, my eyes would bleed out of my head.

I honestly don’t remember a single word of that conversation. In fact, the only thing I remember is getting into bed at around 0130 and waking up refreshed at 1230. As far as I’m concerned, I slept for eleven straight hours. This is troubling because up until now, I have never had a conversation that I haven’t remembered. My sleep assessment is the first incidence of amnesia I’ve experienced (or at least, the first incidence that I've been made aware of). However, once I managed to snap out of the ‘holy exhaustion related memory loss batman’ frame of mind, I was quite impressed that even while I was half asleep, I was able to go through an abdominal assessment. Maybe I should sleep through assessments more often at work (kidding – sort of).

Btw, the sister is not 100% fine but we did have a yummy lunch together. She is no acute distress at present :)

The Customers

It’s nice to have friends who are also nurses. A few days ago, one of my very good friends (I’m looking at you, J) met up with me after a harrowing night shift to vent (errr debrief) about a challenging family member who demanded medical care only to refuse every single treatment option offered. I’ve run into far too many similar situations and they’re a pain in the ass to deal with Every. Single. Time. I greatly respect the fact that a patient knows their body better than anyone else and that those who live with chronic diseases often know more about effective treatments than emergency RNs and MDs. I for one welcome the feedback because it not only enhanced my own learning but allows me to provide better care. However, when patients come in armed with a medical degree granted by Drs Wiki and Google and expect us to follow random internet advice to cure what ails them because they are ‘customers’ of the health care system, it’s not going to happen. Ever. Why? Because we use best practice guidelines to provide COMPETENT and SAFE care even if that care contradicts the generous stacks of printouts from magicunicornhealingpower.com. There are LEGAL ramifications to not providing care that is based on sound science.

One of my most irritating encounters happened with a middle aged man who came in complaining of shortness of breath. It was clear he had pneumonia (what with the raging fever, gunky sounding lungs and the dramatic expectoration of army fatigue coloured phlegm) but he absolutely refused the antibiotics citing concerns about antibiotic resistance and his consumer power. And yes, he had stacks of printouts, mostly with ads for weight loss remedies on the side, to ‘argue’ his case. Logic did not have a place in that exam room. I hate to get all flustered, but WTF??! Why bother coming into emerg at all?

This whole business about the customer always being right is total crap when it comes to providing safe, competent, evidence based care to a ‘customer’ who picked up their medical knowledge from internet pop-up ads and snippets of TV shows.

DISlike

It’s 0200, I can’t fall asleep (again) because of insane switch overs between days and nights so I decide to boot up my computer and watch some mindless movie to pass yet another insomniac night. While I’m randomly surfing, I check my facebook (of course) and this doctor with whom I had a major kerfluffle with regarding scope of practice and respect in general sent me a friend request! Not gonna happen. In fact, the privacy settings got bumped up even higher. Now I’m just too creeped out to sleep.

We (Still) Have No Cure for the Flu

The flu season is upon us and that means snotty noses, fevers, body aches, chills and generally feeling like crap for a while. You want to feel better quickly and that’s understandable. After all, having the flu sucks. But if you’re an otherwise healthy individual (ie: not old, no pre-existing respiratory diseases, etc), please don’t go to an emergency department demanding that the nurses and doctors give you Tamiflu. You’re depriving yourself of the comfort of your own home and bed and are spreading your germs around to people who are a lot sicker than you. There’s nothing we will do that you can’t do for yourself, like resting, taking Tylenol/advil for symptomatic relief and drinking a cup of hot tea. Also, if you’re a 20-something year old man-child, please don’t send your mother to the nursing station every 20 minutes to ask when the doctor will see you and if he can get something hot to drink. I’ve given your child Tylenol (which the doctor would have told you take anyways) and there’s a Starbucks in the lobby 10 feet away from you. They have all sorts of hot beverages for your precious baby. Following these tips won’t make the flu go away any faster but it will save you a huge wait time next to the drunk who keeps pissing himself that you could have spent sleeping at home.

Is it possible to eat so much that your stomach starts to displace your internal organs?

Normally, I consider myself a discerning glutton but this holiday season has been filled with eating on a scale unheard of until about 10 days ago (right when I wanted to pick up working out on a consistent basis again). Normally I don’t eat during night shifts but when I worked straight nights during Christmas, I was powerless to resist the goodies of our annual Christmas potluck. I was deliriously happy when I realized that the majority of my coworkers were amazing cooks on the side! Then I was stuffed silly by my elderly relatives as soon as I got home from work. Tonight is not going to be any different. In fact, as I write this post, I have 3 beef dishes on the stove and some baklava in the oven for a dinner party tonight. The point of this post? I’m far too stuffed to write anything relevant to nursing so I’ll just raise a glass to great food shared with great company, holiday shifts that were uneventful and let me have a chance to actually get to talk to my coworkers and wish you all a very happy and healthy new year!

In need of some Jamz

I think I need to start working out (on a regular basis) again. I don’t particularly enjoy working out. When I’m in a gym, I feel like I’m going nowhere (literally) fast. But as I get older, I’m actually feeling my metabolism slow down to a being a little faster than a speeding slug. And my love of chocolate, baked goods and carbs in general seems to increase exponentially day by day. I’m also not ready to confront my family history of heart attacks and diabetes anytime in the next couple of decades because I know I’d be a terribly non-compliant patient. Since I REFUSE to deprive myself of delicious foods, I have realized that I must pay for this by working out. So dear fellow bloggers – I need your help. The only way I can keep up with high paced workouts is by music. So tell me your favourite songs to work out to or just madly dance around to! I’m open to pretty much all genres of music – 70s, 80s, 90s, top 40s, dance, pop, rock, hip hop – anything goes as long as it’s got a good beat and it’s fast! Looking forward to all your suggestions and not hating my work outs :)