A Sad Truth

The other day I was meeting up with my in-laws at a mall parking lot to drop my children off.  When we arrived there was a helicopter flying someone out, ambulances, fire trucks and police cars were everywhere.  Nothing unusual for an emergency where they are flying someone out.

After the helicopter leaves I decide to take a nap in the car while waiting for my in-laws to arrive.  Great music was playing in the background, it was relaxing and I had a long day of work ahead of me.  My kids were occupied, the AC was blasting, it was perfect.

Ten minutes pass by in a nice slumber when I'm startled awake by a tapping at my chamber door (window, just the car window).  I see an unmarked police van parked in front of me and an officer at my window.

Officer, "How are you doing?"
Me (a little confused), "Good, just taking a nap before work."
Officer, "Where do you work?"
Me, "I'm a nurse in the ER down the road."
Officer (laughing), "So you understand why I woke you up."

At first I had no clue why he was waking me up.  It dawns on me quickly the way it looked.  I'm in a large parking lot, not many people around, it's cool and I'm in a shady spot.  The officer thought I overdosed.  He was checking to observe the situation to see if he needed any backup.

We have a good laugh, I thank him for checking up on me even though it wasn't necessary.

I thought about it later and realized that's sad.  We live in a time where people are overdosing daily.  In the ER where I work it's unusual for us to go a day without treating an overdose.  And it's happening in cars as well, just do a quick google search of overdose in a vehicle.

I'm glad the officer checked up on me, if something had happened my children would have been cared for quickly.

Why?

So I feel like I'm using this blog as a venting ground but whatever.  If I don't I'm going to snap at someone and put myself at risk of losing my career.

My day starts off with my supervisor asking me to come in early.  Apparently one guy is targeting me and a handful of others and tattling that we have cell phones out in the department. He is also claiming my documentation isn't "up to par" and they have a lot of things to do when my shift is over and I've left.  He's targeting me so much that I'm one step away from being written up and put on probation.  He hasn't confronted me, he is spineless and would rather stab you in the back.  I'm pretty close to telling him off (I'm probably never going to do it, I don't do well with confrontation).

I clock in and start my shift, already disheartened from the situation above.  I get an ambulance in one of my rooms and this person is really ill.  He has a pneumothorax (a collapsed lung) in addition to pneumonia and a shitty medical history.  I've taken care of him before and he is really sick.  He gets intubated because he can't tolerate Bipap (a breathing machine, puts positive pressure on the lungs, not a good idea for the pneumothorax) and he isn't doing well on his normal nasal cannula.

Long story short (too late) as the doctor is inserting the chest tube (he has received rocuronium and etomidate for the intubation process) he goes into PEA (pulseless electrical activity, the machine picks up on the heart rhythm but there is no heart beat).  Start chest compressions and ACLS protocol.  He goes into V-tach (ventricular tachycardia, not a good rhythm, needs to be shocked ASAP) and finally after 30 minutes of working him we get him back.

This person is 1:1, I need to be in there and I can't leave him alone.  He gets an A-line (inserted into the artery to give us accurate blood pressures and instant changes), central line (IV access inserted by the doctor that goes deep into the larger veins), peripheral line, and intraosseous line (IV into the bone) by the time we're done.  I end up working with this patient for almost 4 hours before I can do anything else.

While working with this patient someone else takes care of my other 3 patients.  She discharges 2 of them.  The charge nurse puts a sick person in one room and at 3pm she leaves.  She never told me about my new patient. She never asked anyone to watch that patient. The person who cared for and discharged the other patients left at 3pm also.  I have no clue what's going on outside of my 1:1.  The next charge nurse puts another really sick patient in my other empty room.  In my opinion those rooms either should have been closed or they should have received a different nurse to take care of them while I was with my sick patient.  Nope.

Backtrack a little.  I have a patient being admitted because she is having difficulty breathing.  The patient is in no acute respiratory distress, she is actually able to complete sentences without struggling to breathe and she is stable.  She is in room 32.  While I'm literally doing chest compressions Someone asks me to answer the phone because the hospitalist needs to talk to me about room 32 and how she needs me to put orders to change her room assignment.  I ask the messenger to tell the hospitalist to do her own fucking job (I'm not sure it was relayed in that manner).  I continued to get requests from the hospitalist regarding room 32 like why didn't you change the bed request or can you administer meds or can you put in orders for me.  Each time I had to explain I was in the middle of taking care of someone else and she would either have to do it herself or wait (guess what she did, if you guessed she did her job YOU'RE WRONG!).  At one point I finally got some orders in for this lazy, incompetent POS hospitalist and I ask the lab to draw her blood because of everything going on.  They come over and inform me the patient has a port and they can't access blood from a port.  OK, well I didn't ask her to access the port so I assume the lab tech drew blood because she moved on.  There are other ways to draw blood, just because a patient has a port doesn't mean you can't find a way.  I guess that's my fault for assuming.  She had walked off without drawing her blood, leaving me to do it for her.

While I'm still dealing with the aftermath of my sick (almost dead) patient they continue to give me ambulances and expect me to care for them as well.

Even though I'd never walk away from a job (I don't ever want to put my license at risk), I was about to snap.  My usual mostly composed responses to frustrating questions were a little testy and snide (like room 32 asking for dinner even though her blood sugar was 700, my response to the messenger was "tell the fat fucker to stop eating like a pig so her sugar is more easily controlled and maybe I can give her a trough", hopefully room 32 didn't hear that).

This makes me wonder why it's OK for nurses to fix hospitalists problems.  Why is it OK for them to fuck up and expect us not only to catch their mistake but correct it both in the computer and before it touches the patient?  I don't get paid to do their job and they won't give me money to do so.  So why do I have to put up with their incompetence while they expect us to fix their shit?

I need a mental day. Glad I don't return until Saturday for my next shift.  Until then my job can just fuck off.

My Nightmare

Ever since I was a kid I've had some pretty realistic nightmares.  I wouldn't call them night terrors, just real enough it could happen.  I usually calm myself down quickly after it happens.

Last night I had one, it's been a long time since I've had a nightmare like this.

Here goes:

I was helping a friend explore a house they just bought on a piece of property that had become overgrown.  Nothing horrible, the house wasn't really damaged by much.

The house itself is gorgeous.  It has a red brick exterior with multiple windows (we are somewhere in the south for this dream).  Several vines on the front but again, no real damage to the house.

We go in and start moving things around to get an idea of what needs to be done to prep the house to move in.  While moving things around I find this room that wasn't on the floor plan.

I feel hesitant as I reach to open the unmarked door.  I ignore my gut feeling and reach for the door anyway.

Right as I open the door I instantly regret it.  I see a man jump at me, climb on top of my back and put his hands around my mouth and nose, smothering me.

In my dream I'm being smothered and I freak out and wake up, feeling like someone is smothering me.   It took me a moment to realize the only thing on me was my CPAP machine (it goes around the nose, strapped around my head.

Needless to say, it freaked me out.  Fortunately I was able to calm myself down enough to fall back asleep.

Just for clarification

Over the last few days I've had some issues between myself and other nurses and patients.

Though these aren't uncommon, the ones I'm writing about now obviously bothered me enough that I'm clarifying a few things.

1)  As a Registered Nurse I cannot make you do anything you don't want to do.  You have rights as a patient, I am here to help you know/understand those rights and help you make the best decision for you and your health.

The friends of one of my patients this weekend did not understand this concept.  Even after multiple attempts at explaining we cannot keep a patient if they have the mental capacity to refuse treatment.  She asked multiple times "what if the patient is sick, what do you do then?" to which I responded we cannot treat her, regardless of how sick she is, because she is refusing treatment. I also explained she would have to petition to judges and doctors to remove those rights from this patient.  It is against the law for me to keep the patient if they refuse to stay.  It is that simple.

2)  Going with the right to refuse treatment, if you are going to refuse treatment, why come to the ER?  Honestly, why are you wasting your time and mine?  A patient today was obviously struggling to breathe.  His oxygen saturation on room air was 75% (it should be 93% or higher).  Due to his smoking habits his primary doctor refused to give him home oxygen (fire hazard) and this guy was literally not breathing well at all.  He was given a Bipap to help him breathe and he pulled it off.  He claimed he has anxiety, to which we gave some ativan to treat.  He continued to be noncompliant and removed the mask, refusing treatment, and even refusing to be admitted to the hospital because he did not want the treatment to help him improve.  I kid you not when I say this guy would probably be dead by tomorrow that's how bad his breathing was.  Why waste our time?  I even told him this, to which he did not respond.  After he signed out against medical advice the patient was in the lobby and our charge nurse (leaving his position without telling me for over an hour and I haven't been properly trained to be a charge nurse and he always does shit like this) and convinced him to come back and sign in.  This guy continually called out and asked for his bipap be removed because he was done having it on.  I flat out explained to him if he did not want to continue with the treatment he could sign out AMA again and stop wasting everyone's time (not one of my prouder moments as a nurse but sometimes it needs to be said).

3)  In the ER you will get seen and treated, it just might not be in a timely manner.  For crying out loud, it's an emergency department.  Yes we understand it is an emergency to you but if you can argue with me why you need to be seen next while I have a patient who can't breathe, chances are you're going to have to wait.  Please be patient, very seldom can I convince the doctor to skip over patients who have been patiently waiting their turn to help you out (unless you aren't breathing, I can usually pull someone away for that).

Also, if you are able to walk to the bathroom, please walk to the bathroom.  Shitting yourself and expecting us to clean your ass because you "can't reach because you left your special tool at home" doesn't do us any favors (I gave him the wipes and "had to take a phone call". When I returned 15 minutes later he somehow managed to clean himself without his special too. A miracle has occurred!).  In case you weren't aware, you aren't the only patient either.  Yelling out every 2 minutes while I'm helping another person will only aggravate any nurse and you honestly don't need your gown tied around your neck, it's not high on the priority list.

4)  To the RN I'm giving report to, I don't have to secure the IV the way you want me to.  As long as it is secure and won't fall out, what does it matter?  Access is access.  If it bothers you that much how I'm securing the IV, you can secure it however you want after it is your patient.

5)  Live patients come before dead ones.  Yes I understand I have a ton of paperwork that needs to be completed and a bunch of phone calls to make but when you give me an assignment with 2 live patients, 1 deceased, and tell me to relive a lunch (giving me 7 patients when I should only have 4), the documentation on the deceased doesn't have to be done immediately.  In the words of Izma (Emperor's New Groove, great underrated Disney movie) "Well, he ain't getting any deader!" I will finish the paperwork as soon as possible.  I will take care of the live patients first, they actually need help and I don't want another dead one to do paperwork on (or actually give me the support I need to care properly for all the patients you gave me).

6) Going back to #2 and #5, just because your patient has finally stopped playing games and agreed to be admitted doesn't mean I can stop everything I'm doing to take him to the ICU.  Right as he finally stopped playing games and agreed to go upstairs, an overdose arrived.  I have managed several overdose patients in the past, this isn't my first one.  I understand you have managed several overdose patients as well.  You're not going to convince me to take your patient upstairs just because "administer narcan and he'll be fine" usually works.  You didn't hear the full report on the overdose.  That report was "narcan was administered and the patient is still unresponsive".  This means your patient, as bad off as he is, is still breathing on his own and doesn't take precedence over the overdose.  My patient has already been intubated while yours can breathe freely (loose terminology on the breathing freely part, remember he is sitting 75% on room air while sitting, drops lower than that when exerting himself).

7) Patient care comes first, dead or alive.  All those techs working in my ER stocking shelves instead of getting the EKG on the chest pain, way to save lives.  That STEMI can wait, those shelves won't overstock themselves.  I don't need help cleaning up the 300lb dead patient to prep him for the morgue.  The overdose next door, hey your help isn't necessary in there either.  You make sure those shelves are overflowing with supplies because that's what is important.

8) To the overnight staff planning and prepping all the potlucks, thanks for helping us feel like we're part of a team.  Purposely waiting until all the day shift people have left yet having all the staff know what's going on makes us feel great.  Pushing back the time just to make sure any day shift stragglers are gone is also wonderful (they stopped serving their potluck meals at 7:30pm, pushed it to 11pm and about 2 weeks ago it is now served at midnight).  This is such a great team building exercise and helps us feel so included. Forgive me if you invited everyone else and somehow I didn't get the memo for the baby shower and didn't bring anything. Thanks.

This concludes my list of things I needed to clarify after a long weekend of work.  I do work with some great people, unfortunately I'm not always scheduled to work with them.  And as for the techs not helping patients, we've attempted to have our boss explain what should be done first to no avail.

Where are the Gentlemen?

I took my family to a fancy restaurant in our area to celebrate our 12th anniversary.  It's not something we do every day, or even every year (most of our anniversaries are spent at home with pizza delivery or at a chain restaurant, nothing bad, just not fancy) so we thought it would be fun.

This restaurant isn't one of those that require black tie attire but after 5pm they do require "business casual".  Basically they don't want jeans and a t-shirt.

I make the reservations at this restaurant well over 2 months before our anniversary just because of the lack of "fine dining" in our area (we live in WV, most people consider Cracker Barrel or Golden Corral "fine dining" here) I wanted to make sure we have a seat.  The reservations are made without a problem.

Fast forward to the actual dinner night.  This restaurant is hopping.  Way busier than we've seen in the past (the one other time we went).  Turns out that it is both Prom night for the small city but it is also college graduation for the campus next door.

Busy.

As we sit there at the dinner table I'm observing some of the other parties near our table.  I notice one of the prom girls at one point get up to go powder her nose.  As she returns I notice her date push the chair out for her.

Admittedly I am no scholar in turns of what would be considered appropriate etiquette, especially when it comes to eating at a fancy restaurant (hell, I still put the fork on the right and the knife on the left because you're supposed to use the fork as a shovel to get the food to your mouth, right?).  One of the few things I know is when you're date leaves the table you should stand up (or at least rise) and when they return you stand up and pull the chair out to help her sit back down.  This guy reached across the table and pushed the chair out for his date.  In the same manner you would push the chair out for your sister at home.  He never stood up, just half-assed his way to "being a gentleman".

I was ashamed for him.  What's the point in half-assing your way to a gentleman?  If you're going to try go all in.  Once again, I'm no expert but I know that.  I'm sad for this generation.  Here's hoping I can teach my boy how to be a gentleman when it's time.