Sunday, August 30, 2009

sad stuff.

Big bummer, guys. I just found out last night that my little newborn baby boy from last week died a couple of days ago at the Children's Hospital. I have no idea what from- they transferred him out last week, and apparently a few days ago one of the cops was walking around on day shift trying to figure out who the nurse was in order to obtain more info about the guy who dropped him off. I never actually saw him, but I hope the police will be able to tell me more about what happened. I just pray that in no way was this a result of something the parents did. There should be video of their car, so if it was they can hopefully find them. I'll update if I get anymore details. I've been shying away from this lately since most of the stuff that's happened in the last week has been really sad. I'll catch up soon- hopefully with some more lighthearted stuff tonight.

Saturday, August 22, 2009

I know, I know

it's wrong to laugh at psych patients. It is. And I generally feel a lot of compassion towards people who have legitimate psych illness, which this lady certainly had. But tell me if you could keep a straight face through this conversation:
Me: What brought you to the hospital today?
Patient: Well, my heart is beating fast. I had a double heart attack. And my face burns.
Me: Okay. What kind of medical problems to you have, ma'am?
Pt: Well, I have maggots in my eyes and on my face. I have the pneumonia in my stomach. I also have tires, cement, and plates in my stomach.
Me: When did you have your period last?
Pt: I have it all the time, in different places. I have it in my arms.
Me: Well, when did all this start?
Pt: Well, I guess it all started.. with Buckwheat. You remember Buckwheat?
Me: From the Little Rascals? Yeah, I remember him.
Pt: Well, I was giving Buckwheat oral pleasure, and he ejaculated on my face. Now my face burns.
Me: Alright. Well, I'm gonna go give the doctor your chart now. Do you need anything?
Pt: Yeah. Some alcohol wipes to get this off my face.
Me: Okay, I'll let your nurse know.

I don't know if I can really capture why it was funny other than how lucid she was about other things- she could tell us her doctors name and address- and how nonchalant she was about everything she was telling me, like, yeah, you know, Buckwheat, oral pleasure. Whatever. Everyday stuff. The fact that was her reality was sad, but discussing things like that in that manner was oddly funny. I went ahead and skipped the questions about her flu shot, though.

Friday, August 21, 2009

Holy shit, a baby!

I think last night was the first night I have seen literally everyone I work with lose their cool at the same time. The beginning of the shift was crazy, but we were managing- I was managing hall beds and two intubated patients, one of my coworkers had 7 rooms, another had 5 including an ICU hold- but we all kept our cool. The shift died down, we started drinking coffee and seeing Level 4s and 5s. Then it freaking happened.
Unbeknowst to me, a man walks up to the triage nurse and simply says, " I have a baby to drop off." She and the medic up front walk outside to his van to find an newborn bundled in a sheet, covered in afterbirth, blood, and crap, and still attached to the MFing placenta.
I'm chilling at the nurses station when I hear someone screaming for the doctor. That doesn't even happen when someone codes here. I look up to see my charge nurse running with a baby in a bloody blanket back to my room. He sets him down as the doc looks at him and we rush around like crazy trying to find the OB tray and try to learn how to use the dusty old warmer in the corner. Doc clamps and cuts the cords and warms the baby, we wrap him up and toss him in the warmer. He's pink, breathing, and crying, but everyone is still visibly shaken. We try desperately to get vitals on the little guy- his O2 sat kind of blows but the baby warming gear we have in the ER isn't exactly state of the art.
Newborn nursery comes down and checks him out- he's a little underweight and jittery and hungry but otherwise fine. Cute as can be. I think we all just wanted to pick him up and hold him as soon as we realized he wasn't broken, but he really needed to stay in the warmer. Nursery took him upstairs to correct his low blood sugar, and we stood around and tried to sort out the mess.
Do we need to report this to someone? Who? What the hell are you supposed to do with the placenta? Does it go in the biohazard waste? The sharps? Huh? We actually had to call L&D, who called the doc who wanted it sent to lab for tissue samples, so they had to bring me a plastic bucket to put it in. Meanwhile housekeeping is super pissed at me because I've left a tray full of placenta in the room, but I have no idea where else it should go at this point. On a related note- how does anyone eat that? It looks like a jellyfish covered in blood. Then I had to call the lab and ask if there was a special window to drop off womb squid, or if I'm just supposed to leave it on the counter like I do blood. I don't think they much appriciated my questions, but i do not do this everyday.
After the initital shock, I just got kind of sad. I hope he finds a good home- he was a perfect little baby boy that so many people would love to have. It just bums me out to think of him in the nursery, surrounded by other little babies with families all alone. Not that he'll really know since he's a newborn, but I hope the staff gives him extra love. Oddly, it made me kind of excited for the day that I have kids in how immediately I felt connected to the baby. I can only imagine it must be a hundred fold when you have your own kids, and it makes you wonder what kind of person could give something like that up like they were dropping off an old sofa. In a sad way, that's probably the best thing that mother ever did for her baby.

Monday, August 17, 2009

Why I love my team and why day shift can suck it.

Arg. Last night was kind of crappy. We had zero tele beds open, which meant anyone with chest pain of any kind over the age of 40 got to stay overnight, all night, in the ER. Not a big deal- it actually ended up being okay, but the end of the shift was frantic because all of the admitting docs order repeat cardiac enzymes and EKGs right at shift change, plus all the AM blood sugars and other floor nursing crap that I don't normally handle and such are due. It always happens that beds open up at shift change, too- naturally two of my patients got beds at the same time. So in the last 30 minutes of my shift, I managed to get orders in, cardiac enzymes sent, vital signs updated, report called, and blood sugars done on all the patients going upstairs, since tons of the rooms up there had opened up and they were about to get slammed. All the med orders had already been sent to pharmacy and all the charts were broken down. I spent most of the time before that working on a guy who came in with a pressure of 190/120 and chest pain. It wasn't a big deal, it was just lots of steady, frantic work.
So, I get my stuff together and I'm giving report to day shift on all of my rooms. The only thing she has to do other than find someone to transport the patients with beds is to get a repeat EKG on a patient going upstairs and a blood sugar on a lady if she didn't get a bed in the next hour or so. I'll take this time to say that we have no transport at night, at all, unless we have a medic, which we haven't for the past two days. That means we have to transport our own patients by ourselves. Day shift has patient transporters, as well as a medic for each team and nurse externs, who they use as their transport bitches, so this isn't even really a task. She immediately delegates everything, then looks at me, and in the snippiest tone ever, says, "you need to get the urine out of the rooms, now.". She's referring to the sample cups on the sinks that I always leave there as long as the patient is still in the room, in case the doc orders more tests. The same cups that day shift leaves for us all the damn time, even when the patient is no longer in the room and hasn't been for hours. I just stare at her and nod, as she interupted me mid-sentence to tell me this. My totally awesome charge overhears it and goes to the rooms to pick up the cups- he then promptly walks back to the nurse, sticks the urine cups about 6 inches away from her face, and says, "They're out of the room now! Is the rest of this acceptable for you? Do you need anything else?" as he steps between her and I. Then he turns to me and says, "Hood nurse, I told you about day shift. If you stay out here, they'll just bitch at you and suck you into their vortex. Let's go home. " We stand up and stroll back to the break room. I wanted to hug him.
I never cease to be struck by how huge the difference is between these shifts. Day people were always so cliquely. You ocassionally get a charge nurse or a teammate who will ask if you need anything to get home, if they like you. I've seen this woman in action enough to know that she does as little work herself as possible and delegates the rest to everyone. Our charge won't leave the floor until everyone is back in the breakroom thanks to crap like today. If we get tied up, he'll triage an ambulance and draw blood for us. Everyone else is the same- most of the people I work with now never stop working until their teammates are caught up- we'll even go help on the other team if we're needed. It's exactly how things should be. I've gone from hating my job during my internship to almost feeling like it's too good to be true. Even if patient situations get bad, I always know someone has my back. And it certainly doesn't hurt when the person who is looking out for you is willing to wave urine in someone's face to get you home faster. .

Friday, August 14, 2009

suck. it. up.

It may be awful, but I have absolutely no patience at all for people my age who are massive babies. Especially if they're in the ER for illness I've experienced and managed, albeit unpleasantly, at home.
I cut people some slack knowing that I have a higher pain tolerance than most, but some of these people are freaking ridiculous. I got a girl in an ambulance today who had eaten some bad taco bell and gotten food poisoning. Sucks. Been there, puking 12 hours straight and sleeping on the bathroom floor. Never again will eat sushi from target. DID NOT call an MFing ambulance. Because I'm an adult. The worst part is, she got sick earlier in the day and could have gone to a clinic. Nope. Somehow she managed this at home all evening, but I guess got sick of it- she was also three months pregnant, but she was 18, so I'm not cutting her a ton of slack. By the time she got there, she apparently couldn't walk across the hall to get a urine sample- how did you walk to the bathroom at home to use it? Oh and her headache- pain 10/10. Okay. Her sister in law was there, too, by the way, with the same symptoms, but she came in through the waiting room.
I almost could have tolerated the drama had she not also been completely resistant to anything I was doing to try to help her. IV? No. As soon as she saw the needle, she flipped out and started crying. Like, sobbing. I've had 7 year olds that handled it better. I hung saline on her, then went to give her medicine for her vomiting and 10/10 headache. I pushed the med in little spurts through the saline tubing, and immediately after I started pushing, she sat up and started hyperventilating and screaming about how she couldn't see. Really? You were stricken blind my normal saline? Because I can guarantee that's the only thing that hit your veins in that time period. I disconnected the syringe and told her to breathe slowly. Then I told her, "Well, you're satting 100, but if this demerol is making you feel like you can't breathe, I can just give you the phenergan? Do you think it's the pain medicine? I can hold it if you want, some people react badly to narcotics."
Her vision was magically restored after that. And she went to sleep. I woke her up when her saline was done, and I had to give discharge papers to baby daddy, who was actually really nice- she ignored most everything I said, then of course needed to exit in a wheelchair. Naturally, she wanted our asses to pick her up put her in the chair without her having to stand. I helped her up, but made it very clear that if she was still too weak to transfer from bed to chair, I would have to restart her IV and go get the doctor. Naturally, I sounded very concerned and she made a miraculous recovery and was able to move.
Maybe I'm being too harsh, but I have been sick enough before to know the difference between not wanting to move and not being able to to move. And sorry, if you're 18 and otherwise healthy, it's the former. Get it together, lady.

Tuesday, August 4, 2009

Things that go wrong, even when you do everything right.

Really, just with odds in life, something like this was bound to happen at some point. The last night I worked, we got this patient on an ambulance. Adorable little old lady- she was about 81, with the complaint that she had run out of blood pressure medicine and that she had started to get a headache and feel bad. She ended up going in one of my team members rooms and we all went in and helped get her triaged and set up. Her pressure was pretty high, but she only rated her pain at about a 3. She wasn't stressed out, and was laughing and joking with us- the only reason she had really come to the ER because one of her in-laws had come over to take her blood pressure and had seen how high it was. We didn't even start a line on her- we put on a heart monitor and the doc ordered a head CT and was probably just going to give her a pill for the pressure and send her home with a prescription.
My teammate got another patient who was pretty sick while this lady was in CT, so I was walking over to help her when I looked over and saw the patient shaking and vomiting on her stretcher. The CT tech said that it looked like she had just had a seizure. We wheeled her back into the room and my charge nurse and I put her on a heart monitor- some really weird junctional rhythm popped up, and she was snoring and unresponsive to pain at this point. I ran to get the doctor, and by the time I got back in the room she was having agonal respirations, like people get when they're trying to die. We moved her into one of the trauma rooms and felt for a pulse- there wasn't one. At this point it became a full on code- we started compressions and the doctor came in an intubated her- we pushed all kinds of drugs until she converted to V-Fib (as my ACLs instructor so eloquently told us, one of the "oh shit" rhythms), which we finally shocked her out of after about 5 cycles of CPR. Unfortunately, she converted to asystole (flatlined), and after 17 minutes, we called it at request of the family.
I understand and deal pretty well with death most of the time, since it's pretty much a given part of where I work. But it's unusual and really eerie to have someone talking to you and feeling fine for one minute and then 15 minutes later, you're doing CPR on them. Almost all of our CPRs come in as CPRs in progress, and the rest generally happen after a patient is already very sick and on their way down. Situations like that don't really lend themselves to you getting to know that patient as a person. You don't get to see them interact with their loved ones or to see what their personality is really like. It was different with this lady- just with a short interaction, you could tell that she was really neat and funny. Apparently, when the medical examiner called the doctor that had been taking care of her, he cried upon hearing that she was gone. Our trauma nurse had a good way of looking at it in that she didn't suffer, and she was living independently until the end of her life. It's just weird to feel like there's something you should have or could have done, some sign you should have caught, that might have allowed the patient to live. I tend to be hard on myself anyway, so naturally I felt like her death was somehow a result of my negiligence since I had collected all her information. I again figured out how blessed I was to be part of such a great team- my charge nurse and the more experienced nurse on my team were both so supportive and reassuring that there was nothing I could have done and that they both would have done all of the same things.

Monday, August 3, 2009

Drunks, and some more drunks.

Ooh man. This weekend was a weekend for partying, apparently. I ended up with the rooms close to the nurses station again this weekend- I've actually starting to prefer them since it's less stressful for me to deal with a combative crazy ass than a nursing home patient desperately trying to die on me, which is always what I seem to end up with when I take any of the other rooms on this particular side of the ER. Plus, it's kind of funny. The room closest to the nurses' station is actually what we refer to as the alcohol room, and it certainly lived up to its name. The night before last, I got a guy in there who had ended up severely outmatched in some drunken brawl- he walked in to the waiting room with the crap kicked out of him. He had a massive laceration to the forehead and was bleeding all over the place as well as a blood alcohol of 325. He spent most of the evening fighting the c-collar we put him in and yelling to anyone who would listen about how he was going to kill the punk bitches who beat him up and how he didn't know who they were, but that he was going to kill their mamas and grandmamas, too. He also wanted to make sure we knew that he was a "for real pimp". Sweet. We sent him to get his neck CT'd, and sure enough, he had a break on his C7. We kept trying to tell him that his neck was broken, which half the time he responded to by telling us that, no, it was actually fine, and proceeding to try and show us that it was fine by moving it. Luckily it was a stable fracture, but we had to get him to sit still so he didn't displace it while trying to staple up the laceration on his forehead. Unfortunately, we couldn't give him any meds since he was too drunk, so we ended up pretty much having to tie him down to a backboard until careflite got there while the doctor stapled his scalp. The whole time, he had his hands in his pants manipulating himself, which he swore was the only thing that would keep the pain from being unbearable. It seemed to at least sink in a little bit when we told him that part wouldn't work anymore if he displaced his fracture, and we were able to transfer him out safely.
Last night was less legit- I pretty much just ended up babysitting a girl whose only complaint was being drunk and vomiting. Sweet. Definitely something that should be managed in the ER and not at home in front of the toilet. Apparently she was drinking with her family at 8 Pm on a Sunday, cause why not ( by the way, she was only 20 and had an 8 month old) when she had too much Crown Royal and started puking everywhere- they responded by dumping cold water all over her, for some reason, and then calling an ambulance because she was "foaming at the mouth". Uh. Yeah. That's called vomiting, and it happens when you drink a bottle of Crown by yourself when you weigh 110 pounds. She was actually pretty cooperative with the IV- less so when I had to catheterize her, but considering she was a drunk puking mess, all was okay. That was, until she remembered that she had a baby and decided she wanted to see him, immediatly, at 1130. When I informed her that she was far too drunk and that I had no idea where her spawn was anyway, she responded by yelling that I was a bitch ass hoe, and that she wasn't drunk. Oh. Okay. We literally had her sleeping in the booze room from 9 to 3 am; during all that time, none of her family showed up or called. Finally, we woke her up and told her we needed to call someone to get her drunk ass. She spent the next half hour after that on the phone telling her cousin how we stuck her, like, everywhere (we stuck her twice, and the first was by an EMS student who would have gotten the line had she not jumped halfway off the bed) and how we thought she was gonna die (nope). She then berated them about how she couldn't find her baby or her weave. When they got there to pick her up, the only thing she was embarrased about was that she'd been seen by the staff without her hair (or hurra). On her way out, she told us she was going to go get pregnant. Awesome, you should definitely have another kid if you leave the one you've got wherever you leave your weave.