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.

Uh, Hell No!

I feel violated.

I received a female patient today from the local jail who was vomiting and a heart rate in the 40s (should be at least 60, maybe 50s for someone who exercises regularly and I think the only exercise this patient did was taking a spoon to her mouth).  Officers are in the room telling her to be patient while we do our job.

I can tell this patient is going to be time consuming because as she was going to vomit she would purposely vomit on the floor.  How do I know this you ask?  She was given two different emesis basins and instead of using them she leaned over the bed on vomited on the floor (classy).

Considering the circumstances I needed to start an IV to help her get fluids, etc.  I get my other patients situated so I can spend time in her room knowing it will be time consuming.  By the time I return the guards are gone and she informs me she can leave whenever because she is no longer in the custody of the police.

She claimed she wasn't interested in leaving and she wanted treatment.  I proceed to tie a tourniquet and stretch her arm out to look for a vein.

Here's where the violation starts.  The picture below is how to search for a vein (if you have a table to assist in keeping the arm straight).  In the ED this is seldom available so we use our bodies (at least I do) to help keep the arm outstretched while searching.

Veins are spongy and will bounce back to normal, arteries have pulses, that's how you differentiate.

The way she is positioned she is able to use her fingertips to touch the inside of my arm (gentle brushing, obviously flirting type), then reached up and touched my chest.  I tell her to stop and to act appropriate during the process if she wanted me to continue.

She stops, I move to look for a vein in the other arm.  Since I am now on her left arm I need to stretch out her arm and lay it in my lap (I start IVs with my right arm, searching for veins with the left).  At this point she took complete advantage of the situation.  She started feeling up my leg working her way up my leg.  Fortunately for me my wallet was in the pocket; she got distracted and tried to remove take the wallet instead.  

As quickly as possible I removed the tourniquet and stand up.  As I was standing up she reached up to my chest again and grabbed the trauma shears out of my pocket, asking if she could keep it.  I yank it out of her hands, remove all sharp objects from her reach and tell her that she is not welcome in the ED if she won't act appropriately.  I reminded her she was no longer in police custody so she could walk out whenever and left the room.

My coworkers (being the great friends they are) immediately pointed out she was in jail and just wanted to touch a man again.  Thanks guys.  She had only been incarcerated less than 36 hours by this point.  I've gone longer than that without seeing my wife (though she will probably claim I do the same thing if I've gone that long without seeing her).

This patient ended up walking out of the room and shat herself in the lobby in front of everyone, then demanded a change of clothes before she would leave.  Paper scrubs were happily provided to get rid of her.

Again, I feel so violated. 

On a side note, I told my coworkers this story and they got confused with the word shat.  It is the past tense of shit, in case you didn't know.  My patient shat on the floor because he was drunk and missed the bedside commode (yes, this was also my patient while dealing with the one above, fun night).

DIY Surprise

Several years ago my wife wanted to renovate the half bath on the main floor.  I don't recall why it never happened but I decided today I would make it happen.  My "quick" DIY projects never turn out as quickly as I would like, I don't know why I thought today would be any different.

First, I needed my children to be away.  That would make it much easier to run to the store quickly and back if needed, minimal problems right?  My in-laws were planning on taking the kids away after Easter and I would pick them up Tuesday morning.  Perfect, no kids for an interruption.  That means I could literally wake up and work on it as long as I wanted until Wifey got home.  Nothing bad, plenty of uninterrupted hours.

Before I even left work I get a text message that my in-laws were ill and couldn't watch the kids.  I should have seen it as an omen.  

I decided to proceed, it's not difficult to make a quick change in sinks right?  I inform the kids and we start the day running to the store after breakfast (easily a good 2 hours later than I anticipated).  I also need to run many additional errands now that I have the kids.  Still, I can manage, right?

This sink has been here for almost 12 years, not bad but obviously lacking something.

So I return from the store with my stuff to swap the sink out.  Removing the faucet wasn't a problem. I then tried to remove it from the wall.  I assumed there was just some caulking around the exterior to help secure it.  Boy, I was wrong.

After well over 30 minutes chipping away at the glue I gave up and tried pulling it from the wall.

DOH!

Lot's of hoping and praying this can be covered without a patch job.

Well, I got it off the wall.  And on the plus side there is no hole through the wall.  Even better the new sink can cover it up without patching anything.  Time to move on to attaching the faucet.  I realize quickly I need something from the store again, load up the kids and lets go!

I get home with the tubing to attach the water to the faucet and now I open the faucet.  Crap! I grabbed the wrong one.  There was an identical name that required a much larger sink.  So much for my surprise.  At this point in the game it's too late to get it finished before the wife will get home.  I conceded and explained to her when she got (ruining the surprise).  At least it looks better.

Kept myself out of the doghouse with the cover up.

At this point I have attached everything except the drain.  After working on this project all afternoon (which should've taken me less than 4 hours) I'm finally at a stopping point.  I give up.  I should just realize that I'm not nearly as handy as I used to be and I should just ask for help.  I wasn't able to get to painting the storm door frame but I at least have everything for that.

The finished product. A much needed improvement from the original sink.    

I need to attach it to the wall but that's a job for another day.  Nobody is going to climb on this (that I know of).

All in all at least it was nice to try and surprise the wife.  A 3 week early anniversary present.  It'll be done soon.

Lazy Americans

I read an article today about how "lazy Americans" are hurting the economy and I gotta say I'm a little offended.

The article starts out with Tyler Cowen, an economist, pointing to the fact that Americans have not started nearly as many businesses were started in 2014 as in years past.  

Have you looked at the startup of a business venture?  Holy crap.  If you want to go with purchasing a franchise you need to have a large amount of liquid assets available, not to mention your net worth.

I looked into franchising a donut shop I think would succeed wonderfully on the East Coast.  Ever heard of Shipley's Donuts?  Oh my they are wonderful.  To franchise this company they require $200,000 liquid funds, $600,000 net worth, not including ability to purchase land in the area you are looking to build.

Most Americans I know don't have half of that even available.  Hell, even going a cheaper route would be the Taco Truck thing.  I've looked into it and it would still take almost $20,000 just to have a pull behind taco stand to set up.  That doesn't include purchasing recipes (I am no chef but I've found several recipes that are terrific, I would feel obligated to reach out to those whose recipes I would use and purchase them), advertising, food costs, utensils, plates, the list goes on.

I wouldn't consider myself a Lazy American by any means but I definitely won't be starting any businesses just for the simple fact that I'm trying to get out of debt, not dig myself deeper.  I work my ass off for what I have and so does my wife.  Besides, I like to travel and if I were to open a business I wouldn't be able to travel at all unless it becomes a successful business, and that could take several years.

And no way I'm going to be a landlord, been there, done that (at least assisted with my father's slum lordship and I'm not going down that road, especially with this economy).

He claims we Americans have created an insulated life for ourselves and our children and we're afraid of change.  Ok, I'll give him this point.  Change is scary for a lot of people.  I look to my own family and extended family and I see a lot of people going through the same motions because they are afraid of changing their norm.  They complain about their life on Facebook but do nothing to change it (and that's part of the reason I'm only on Facebook a few minutes a day, my eyes can only roll so many times before they start to hurt).  Even our little family has a routine that is difficult to change (we allow a lot of flexibility but for the most part it's the same, even down to the food).

Cowen also reports that we Americans aren't moving as often as we used to.  Is that a bad thing?  Living in one house usually means you're paying your mortgage down.  I've lived in the same house for almost 12 years.  We would like to make some major changes to it now that we can afford to do it but financially it doesn't make sense (to me, wifey might think differently at times).  Yes we could probably sell our house but it would be at a significant loss from when we purchased it (right before the crash when everything was inflated).  The only thing I would want to do is move closer to my wife's job so she doesn't have to commute so far but the houses in that area are a lot smaller and have no land (I need the land, I can't live so close to people, they bother me in large groups).

The article continues stating there is a great reset going to happen soon into Trump's presidency.  He claims it usually happens after a great trauma or war (considering we've bombed Syria and Afghanistan in the last few days, I'm leaning toward a war).

The last thing I'll point out from this article is the fact that he wants people to take more risks in their personal lives.  Once again, I'll give him this but only to an extent.  Making a change in your life to improve it for the better is always a good thing.  Taking a risk here can be extremely beneficial in many aspects.  But before just "flipping a coin" there should be a lot of thought and consideration that goes into the decision.  In addition to studying out the options one should pray for guidance (I will always encourage someone to reach out to Heavenly Father for guidance, as long as you believe he will help direct you).

After working in group homes and the parks and recreation department for over 10 years I realized I wasn't going to ever support a family.  I needed to make a change so I returned to school and became a nurse.  It wasn't cheap (combined debt for 2 bachelors degrees was well over $50k) but it has been significantly better for our lives.  Now at this point in my nursing career, as much as I would like to further my education it doesn't make sense.  I would have to return to school (not a bad thing) but that would take time away from my family for the 2-4 years.  It would incur more debt, probably close to $100k, and I won't even double my current annual income doing this.  Is it worthwhile?  Probably not (it hasn't stopped one director from trying to convince me to return).

Going back to the offended part, just because we're not taking as many risks to "help the economy", why does that make us lazy?  There are many more educated people out there than in the past, many of whom are living frugally so they can save for a nicer retirement.  Or vacation.  Our captivation on the internet is living vicariously through people who can afford to do things (at least for me).  Why is it wrong to live frugally, save money, so we can have that week or two extravagant vacation with a few other nice outings while we wait?  Once again, I work my ass off as does my wife, for what we have.