Saturday, May 16, 2009

blog neglecting and young eating

...they continue. But, there is an end in sight. I got released from my internship this week- woot- which means at the next schedule I can finally move to nights and stop defying my body's urge to stay awake until four in the morning. Naturally, this didn't happen before another installment of events to show me that I can't really trust any of these assholes- well at least not most of them, especially on days. Dramz you guys- this lesson has come to me in the form of my first preceptor! The one that has been telling me this whole time, despite my very candid doubt as to whether I could do this, that she knows I can do this, that it's just hard because I wasn't an extern before, that I shouldn't give up- well, apparently that isn't actually what she thinks. Apparently the whole time she has been telling my manager and our administration that I'm unsafe, that I can't do this, and that I need to move up to the floor. She's also been recruiting other nurses to watch me for unsafe behavior. The hell? I mean, if this is actually what she thought, I can't really fault her for it- it's her job to see if I'm cut out for it- but why in the hell would you not tell me if you think honestly that if I continue working here I'm going to screw up and kill someone?
The funny part is that I've done really well with my new preceptor, who totally rules, because she actually teaches me things. I found out about all this fuckery through her, pretty much because she thought I already knew because she actually had the expectation that there would be honesty in the preceptor-intern relationship. It's the best thing that could have happened, though, because my confidence really has been restored by the whole thing. The more I've learned, the more I've figured out it really was her and not me. She's that back stabbing with everyone, and I think at some point she realized she was going to be held responsible for not being great at teaching and decided to throw me under the bus to make herself look better. So, whatevs, that was pretty douchey, but stuff has been okay. I haven't seen a lot of funny stuff, but a lot of crazy business has gone down.
We had a shit ton of people on swine flu week. Like, more than the hospital has had ever. One day we literally had ambulances waiting in the hall to go to rooms for about 45 minutes each, and the people in triage went through 4 boxes of surgical masks in one day.
The next week we had crazy ass overdose day, where everyone came in full of something- the peak was the patient I got in the trauma room, naturally, at the end of my day at shift change. It was the most insane shit ever. According to EMS, this man had just strolled into a hardware store, picked up a jug of acid, and started drinking it. A bunch of customers followed him outside where he collapsed, and when they brought him to us they couldn't even figure out what his name was because his driver's license didn't match his passport. He was from Haiti and couldn't speak English, so no one could figure out who next of kin was or even where he lived or worked. When I put the foley in him his urine just came out green. I talked to the nurse who had taken the room the next day, who said that he had made it up to ICU but that he probably wasn't going to live. Very sad and strange.
This week I ended up with a patient in some kind of psyc related catatonic state- she didn't respond at all to being catheterized, her drug screen was negative for everything, nothing on her head CT, and when the doctor did a lumbar puncture and poked her repeatedly because he couldn't get through the vertabrea, her biggest response was to flinch a little bit. It was very strange.
The rest of the notable people have pretty much been noncompliant to the point of being enormous pains in the ass- always massive trainwrecks pretty much due to their own actions. Last week I ended up with a guy who came in on bipap who eventually had to be intubated who constantly asked me if he could smoke a cigarette while he was on bipap. No. Absolutely not. You could easily die, the cigarette is not a priority right now.
My patient yesterday was even worse. He was thirty five and already had kidney disease, congestive heart failure and COPD, along with tons of other shit- of course, he was morbidly obese and refused to take any of his medication. He was in a nursing home with all this crap and came in to our ER because his heart rate was in the 150s and he was full of fluid that wouldn't respond to Lasix (pretty much the most effective diuretic there is)- by the time he'd been there two hours it was already up to 170 and his blood pressure was slowly but surely spiraling down the toilet. All he did the entire time was bitch. Not about anything important, but about how it was too hot, that he wanted a fan in his room, that he wanted more pillows, and that we came in and "bothered him" by taking his blood pressure, even though we were only doing that hourly. His mom was there and continually demanded to know what was holding up "getting that fluid off him". Um, his kidneys? I took some time and explained the reasons as to why he might not be responding to Lasix and how there really wasn't anything else we could do until we figured out what was going on. After going through this about three times she was finally alright.
As soon as I let them know he was getting admitted they both started asking non-stop about why he wasn't getting moved up to a room yet. Um. Because there isn't one. Just like there wasn't one five minutes ago when you asked me the last time. He asked me multiple times for pain medicine for a stomach ache- when I finally talked the doctor into giving him some, he refused it. He finally took it when I let him know the codeine would help his cough go away (on top of everything, he also may or may not have had pneumonia, what the hell), but he acted like he was doing me a big favor by taking it. His reason for refusing it- it would make him go to sleep- even though an hour before that he had asked me for a sleeping pill. In the ER. At 2 in the afternoon. No. Just no. I really think he was just looking for a reason to bitch and moan. Any time I was in the room taking vitals or giving meds, he complained about me messing with him, but as soon as I left, he sent his mom out to ask where I was and when I went back he asked me why I was neglecting him. When I finally got a bed, I let him know I would be right back in about 8 minutes to move him to the floor but that I needed to check on my other patients and give meds to one. At this point I had two other rooms and a patient in a hall bed that I hadn't even seen yet. He responded by asking why I was ignoring him and why he had to wait. I took him up with a relatively small medic, and it was pretty much the two of us trying to move him into his ICU bed- I can lift about 60 pounds max and this guy is about 350 plus and has no real condition that would prohibit him from helping us a little bit- the whole time he is doing nothing other than yelling at us "Hurry up! My ass hurts! This bed is uncomfortable! I want in the big bed!"
Luckily I had some very sweet patients that day, including one who kept telling me what a great job I was doing and how I had wonderful potential and he was going to let everyone know, so I didn't immediately want to quit my job, but man. If I'm developing any skill, it's definitely patience.


  1. Such BS. I love this when patients who are sick as hell just don't seem to get it, and whine about little stupid stuff.

    That is WRONG with your previous preceptor. If they think you are dangerous they should be honest and tell you directly. They should also teach you what you are doing wrong, and how you should be doing it correctly. Otherwise, how else are you to learn? Passive-aggressively going behind your back is going to help no one.

  2. sound like you're doing just fine to me. I was released from my residency phase this last week too and I've already felt like a shitty nurse every single day I've worked. I never cried once during residency and then I cried 3 times in one day, and once in front of a pt. without meaning to. I couldn't get out of the room fast enough before the fell. I wonder how we'd do in each other's ERs.


  3. I think it's all due to working in ERs where they are way more patients than there are beds or nurses. We should probably drink together again soon.

  4. Don't worry about that first preceptor. Her kind are all over the place. And they don't just get after new nurses....but new old nurses too. I can remember being told by an RN orientating me (this was only 10 yrs ago after 25 yrs of nursing!) to measure a belly of this poor multip woman writhing mid labor....and I had the audacity to ask..don't u think she might need a VE first???(quietly and not in front of the patient) and she reported me and then refused to orientate me. Hahaha. I think you probably made the first preceptor feel inadequate and insecure because you sound confident and seem to know your stuff. Take pleasure in that. :) I really never did understand that "eat your young" thing.