Realities.

Today I am in Wisconsin, hanging out with a really good friend from college. Life is good.

3 days ago I was getting ready to work my 6th day in a row when the phone rang. It was my bank telling me of suspicious activity on my debit card. Someone managed to empty out my checking account over the previous 4 days. Life wasn't so good then.

That night I went to work already beyond stressed, only to discover a post-op patient with a trach that wasn't on oxygen, was struggling to breath and desperately needed suction. I did, and pulled out what looked suspiciously like his tube feeding from his lungs. His life isn't going so good either. I spent the night suctioning his lungs every half hour. checking his blood pressure as it came too close to tanking too many times. Calling doctors for fevers, blood sugars, crappy lungs and urine output of less than 200 over 12 hours.

Did I mention the dude didn't speak English? That makes things fun.

I do not understand the medical community sometimes. This man did not become so sick that day. His lungs were pretty bad before they took him to surgery and removed one leg and completely redid his veins in the other. He had so many co-morbidities that I sit here and wonder what the doctor was thinking we would accomplish?

Some nights go better than others. Some nights you swab wounds and culture sputum and check UA's without orders, cause the order will be written first thing in the morning anyway. Some nights you can make the night without calling a doctor, some nights you have to decide which one to call first.

By the time I left, his lungs sounded marginally better, his secretions were thinning out thanks to the mist and the breathing treatments and his blood pressure and urine output were improving thanks to a fluid bolus. I think I improved the situation... his situation. In that shift, I made a positive difference.

But really? In the long run, at what point is it okay to say that someone has no quality of life left, maybe we should stop the invasive procedures and just manage symptoms? at what point is it okay for me as a nurse to start wondering why I have to be doing all the things I do? I firmly believe that there is a good way to die. I just don't think we let people do it often enough.

Thursdays.

Here is the e-mail I sent my dad the other night:

I think maybe I am just cursed in winter.

My patient just coded.

Drats.

It might be a long couple of months.

(in other news... I have no news. i was having a good night. until I walked in the room and my patient wasn't breathing. that kind of killed the good night. )

I hope you have a good day. And that no one stops breathing during it.

At least I didn't have to do compressions, although those are kind of fun.

I would still rather not have to do them... I will take a beating heart over a not beating heart any day. Even without breathing.

Now, give me a patient with both a beating heart and the ability to breathe, and I am a happy camper.

I don't think I ask for much, do you?


Sometimes the way my brain works while I am taking a 5minute lunch break at 5:30am worries me. I don't really think chest compressions are fun. Really. I do like it when my patients are breathing, that much is true. I really cannot tell you how much I liked going back to work last night and having that patient back on our floor... he is okay! Or as okay as someone could be who stopped breathing for a bit. Life is Good. I finally had a code patient live.

3 crazy days

I worked this past weekend and Friday as well, and boy did I have a crazy three shifts! It started with a pretty busy morning, my favorite part was helping the vascular surgeon put in a chest tube! It was awesome!!! It was the first I had assisted as the primary nurse! The patient did it on 0.5 mg Dilaudid and local anesthetic which probably explains why he jumped 6 inches off the stretcher! The surgeon was mad!! He was like "I said don't move!!!" I felt sorry for the guy, it was a spontaneous pneumothorax and he was only 26, he nearly cried.

After that, I got my first review as an RN and I got high marks! I was pleased to discover that my coworkers enjoy working with me and my boss thinks I am doing a good job!

Saturday was a strange day, we saw barely any patients all day long until 1500 when we got a call from EMS saying they were bringing in a 25 year old unrestrained driver involved in an accident on 95, she had been ejected 40 feet from her vehicle. Originally they were brining her to us to be pronounced because no one ever dies in an ambulance but halfway to our hospital she got pulses back so we were gonna have to stabilize her then fly her to Halifax. Right after that trauma call came over the radio we got another saying that a 7 year old in respiratory arrest was coming in. 7! I was ready to freak out because I had the pediatric trauma room so that patient would automatically go to me!

I raced around my room, hooking up the small blood pressure cuff and whipping out the Broslow tape, all the while terrified because I knew half the help would be with the trauma and not in there helping me with the child! Thankfully, we got a correction on the age and it was a 75 year old not 7. I was relieved but still nervous. My respiratory arrest arrived first, intubated, and as they rolled her into the room, they handed me the DNR. I was very confused as to why they had a patient with a valid DNR intubated but we rolled with it. She was in PEA which means the electrical circuit in her heart was still running but her heart wasn't actually beating. As soon as the doctor came in he pronounced her and we ceased all life saving measures. Dr T asked me to go with him to tell the family and after informing them that their mother didn't make it, the son asked what do we do now? Dr T says "RaDonna will tell you" and he walked out of the room.
Keep in mind that this is my fist expired patient and I have never had to deal with grieving family members before so I did my best and was as kind and compassionate as I could be and I called a priest for them and after removing all the tubes and cleaning her face, I let them come be with their mother. It was scary dealing with this new experience and also with preparing the body but you just have to take the hand you are dealt and learn to adapt.

My charge nurse was also very nice and helpful and he showed me how to fill out all the paperwork and told me everything I had to do. The rest of the day went pretty uneventful but we were all a little somber, especially when we found out that the trauma victim didn't make it.
Sunday was a crazy day. I think it was actually a full moon. I had this one nice lady who was only a couple weeks older than my mom who came in for new onset seizures. She was very scared and worried that maybe it was a side effect from the flu medicine she recently started. Unfortunately, after a CT scan, the ED Dr. diagnosed her with a frontal lobe tumor. She had never had cancer of any sort and this came as a complete shock to both her and her husband. The week before they had buried a family member who had died as a result from cancer. I felt completely incapable of caring for this woman emotionally which is part of my job as a nurse. My heart ached for this woman who after sobbing in her husbands arms for more than half an hour, just sat on her bed, staring at the sheet. There was absolutely nothing I could do for her. All I could do was work on transferring her to nearby Hospital for neurosurgical care.

Meanwhile, in room 9, I was given a 15 year old boy who snapped his femur falling off a motor cross bike. He is crying in pain and if that isn't enough to make me feel bad for him, I have to deal with his father in my face at the nurses station asking me why his son hasn't been medicated for pain. I calmly explained the nicest I could that I am realize that his son is in pain and a doctor would see him asap, but until then, aside from an ice pack, there was nothing I could do for him.

(I have had a broken ankle and that hurt like heck so I can't imagine the pain that he was in but seriously, there isn't anything I could do without a doctors order aside from having it x-rayed. Just wanted to make sure ya'll don't think I am heartless shrew. Besides, both docs were busy with a lady who had O2 sats in the 70s and a STEMI)

The father didn't believe me that there was nothing I could do and kept demanding that I do something. Unortunately, my forked tongue betrayed me and I said in not the nicest of tones: "Sir, I do not have a medical license, therefore, I cannot give your son anything for pain! You are going to have to wait until the doctor sees him!" I felt bad afterwards because I can't imagine how hard it is to see your son suffer but he wasn't listening to me! Plus, I was stressed to the max because I had my poor tumor lady in 10, and a SOB guy in 8, AND a pneumonia lady in the hall. I never have four patients and needless to say I was a bit frazzled.

After the doctor finally saw him and I gave him some happy juice, the dad apologized and in my sweetest nurse voice I told him there was no need, because I understood he was stressed.

Everything ended up quieting down and I didn't receive any phone calls today from the Florida Board of Nursing informing me that they would be revoking my license for shoddy patient care so I guess I'm good. I learned so much and had some great experiences this weekend. I wish I could hear how my tumor lady ends up. I don't think the prognosis will be good though because she has developed some abnormality to the roof of her mouth and the CT report said it required further testing. Please keep her in your prayers.

One of the nurses I worked with on Saturday said that one day it will hit me and I will say to myself "I'm an ED nurse". I'm not there yet but I'm getting closer everyday.