Tuesday, October 30, 2012

New Job, New Blog Title, Same Patients Allergic to Everything but Dilaudid

Yup.  New home is the balls, I am crazy excited to be starting a new chapter in my life as evidenced by my new blog name,  which now includes reference to my favorite sequel subtitle EVER.  I feel like this is the sequel in a way- it's still basically the same shit here.  But also it's way WAY better.
Like, omegerd guys.  The patients here, they actually get rooms.  Like, upstairs, on a floor.   And the nurses take report and stuff, and most of them look at the chart and don't ask insane questions.  So then, right, all the patients in the waiting room come back to rooms, and sometimes, the waiting room is empty.  IT IS AWESOME.
And dude, they have IV pumps, and all of the monitors actually work. And I get to eat and go pee here, too.
I have more patients here but they aren't nearly as sick as the ones at Hood Hospital were.  And you get your stuff back faster and the doctors actually don't sit on the patients for eternity so if you have someone really sick or just a pain in the ass you're usually only stuck with them for a little while. 
Hearing people complain here is hilarious.  Day one I worked with ER BFF, and while we're sitting there in report everyone is all "Oh noes, today is terrible, there's a FOUR hour wait."  Both of us had to stifle our laughter. It's not like it isn't hard, or that I don't get stressed, but it's not I "I have a 14 hour wait and I just filled my last bed with a cardiac chest pain and now I have a CPR coming" level stress.  And I don't see it getting to that point, because they have a system set up here that actually seems to work. 
But yeah, the patients are almost exactly the same.  Well, some of them are  literally exactly the same- apparently some of our frequent flyers at Hood Hospital have been cheating on us with the new ER.  (One saw ER BFF here the other day- "hey, I see you're working over here now! Her reply "Yup, looks like you are too!") I have no doubt I'll still have plenty of stories to tell.  To give you an idea, the first patient I discharged day one was here for dizziness secondary to smoking marijuana.   His family asked me if he was getting any prescriptions.  "Uh... no.  See, the doctors thinks he's dizzy because of the drugs... so prescriptions aren't really necessary... he should probably just, yeah.  Not do drugs anymore."
So yes, the same foolishness that I love/hate about working in the ER without the coming home everyday feeling like I'd been out drinking all night and had the crap beat out of me when in reality I'd just been at work.  A little break every now and then from the constant onslaught of crazy sick people with no mercy.  It still feels so foreign- every time I sit down, I'm still in disbelief that I'm actually caught up with my work and I have nothing else to do.  I just always assume I'm forgetting something.  I kind of have that weird disoriented feeling, like when you step down from running on a treadmill and you're trying to get used to the fact that the ground isn't moving under your feet anymore.
I hoped, but I really wasn't sure, that nursing in the ER or in a hospital setting didn't have to be as awful as it was.  It's such a relief to know it doesn't have to be that way.  To know that I can step away and enjoy my days off without looking over my shoulder and feeling like something was going to come back to bite me.  It's so much better, but a little part of me aches and feels guilty knowing that so many of my friends are stuck where I was.  We'll see how it goes in the next couple of months but right now I am loving it.  I feel like I've gotten my life back. 

Wednesday, October 24, 2012

The Last Time

Woo.  Worked my last shift at Hood Hospital EVAR this week, y'all. And I say that definitively because I was thinking about picking up some shifts over there, but yeah, F that noise.  I honestly thought I would feel more upset about leaving.  I felt upset about leaving some of the doctors and PAs, because I really will probably never see them again.  Turns out a few of them also work at my new hospital- unfortunately not the ones I would necessarily want to see again, but oh well.  One of the most poignant moments for me was saying goodbye to big eastern european doc, who has worked there since I was a baby nurse and has yelled at me many a time.  He was always someone whose respect I sought, although I was pretty much convinced he hated me and thought I was a complete moron up until about a year ago, when he seemed to start tolerating me.  When I went to say goodbye to the docs that morning he actually got up out of his chair and hugged me and said he would miss me.  I really had no idea how some of the people here felt until I was saying goodbye and I saw that they actually looked really sad.
Saying goodbye to my fellow nurses was tough too- especially since the two people that I would really say were both my mentors throughout my nursing career thus far were there,  but I know we'll stay in touch.
Fortunately, they put me at triage, which was probably the most solid affirmation possible that I was making the right choice.  Nope, I sure won't miss making sick people wait for 12 hours to get seen, or getting cussed out every time I open the door to call someone to triage.  I won't miss taking care of people in chairs because there are no rooms in the back while triaging 15 people an hour at the same time. I won't miss compromising my license and questioning why I became a nurse in the first place.  I'm sad to leave everybody, but it was past time to move on.  I feel a little stupid for staying this long.  I know nowhere is going to be perfect, but I'm excited to start the next part of my life.

Thursday, October 18, 2012

Go Ahead and Shock Him Into Asystole, Then

So, it sounds funny to say, but codes rarely work out for anyone.  I mean, obviously it isn't a great starting point, but I didn't know til I became a real grown up nurse how seldom CPR actually does anything at all- and that when it does actually "work", we bring people back to the life of a week long, million dollar ICU stay after which they either a)die anyway or b)spend the rest of their life in some kind of long term care center with a trach and a hypoxic brain injury.  Maybe like, a couple times a year you will get someone who is a legit witnessed cardiac arrest where CPR is immediately initiated and the underlying problem is correctable and they get up and walk out a couple weeks later like nothing happened.  And boy, is it weird when those people check back in to the ER.
Unfortunately, this was not one of those cases.  Guy was older and had already been down around 30-40 minutes when we got ahold of him.  But okay, he's not that old and we've got some gung-ho paramedic students here who wanna do some compressions.  Let's give it a shot.  So we do a couple of rounds of CPR- asystole, asystole, what do you know-V Tach-clear!, asystole, that way too long of a pause in compressions for central line insertion that ACLS guidelines don't want you to do anymore,  PEA... asystole, okay, let's resume compressions, and okay, does anyone object to calling this now, because... yeah.  We've already been doing this probably longer than we should have given the circumstances.  Yeah, alright.  Let's call it.  Time of death is agreed upon, and we go to print the strips off the monitor, and WTF? The patient is in V tach again.  Recording nurse is distressed and tells the doctor we can't print off a strip that looks like this.  "That's a shockable rhythm. I mean, I know you called it, but I can't put this in the chart."
Doctor: "Okay, well, whatever, he's been pronounced, but I guess you can shock him into asystole if that makes you feel better." Walks out of the room.
Okay.  Clear!
Except, uhh.. now it looks like some kind of accelerated junctional funkiness on there.  And, holy shit, the patient has a pulse now.  And, could you hit that button please? A blood pressure! Um, can someone go stop the doctor and tell him before he delivers the bad news to the family please?
So yup, this guy is totally alive again.  Well, technically.  His pupils are non-reactive and he's down with no sedation.  His blood pressure responds pretty well to pressors when the epi finally wears off, but, uh, yeah. Here we are now.  The recorder was apologizing to everyone for the rest of the night, but I would have probably done the same thing.
It felt awful, to be honest.  He had a huge, super sweet family who were eternally grateful that we had saved their patriarch's life, and now we've got to find a way to break the news to them that he's still not really there.  They were on the fence about a DNR status.  They said they wanted everything done but they didn't want him to suffer.   I tried to gently explain that it's impossible to tell if he's suffering because there doesn't seem to be much there. The hospitalist pretty much laid it out how it was, but you could tell they were still grappling with all of it.  I'm sure it probably seemed like he had died twice.
That's the thing that kind of sucks about what we do.  Yeah, it's incredible when our interventions save and improve people's lives.  But so often I just feel like we're making it worse.

Tuesday, October 16, 2012


Gal a little younger than me presents with her baby and her baby's daddy for some kind of Level 1 abdominal pain DRAMZ.  Of course, it's crazy busy and it totally sucks and it's way understaffed because Hood Hospital.  Homegirl's vitals are stable and she goes back to the waiting room.
Baby daddy then proceeds to bum rush the triage desk every 5 minutes to berate us about why she isn't getting a room.  It's been around an hour at this point.  We re-triage her, at his request. Yup, you're still okay, I'm sorry it's so busy, as soon as we get a room we'll bring you back, sorry, okay thanks.
Baby daddy escalates even more, finally reaching a crescendo as he goes up to the window and screams at triage partner "HOW LONG ARE YOU GUYS JUST GOING TO LET HER FUCKING SIT THERE IN PAIN?!!" Oh, I'm sorry, did you want a room?  Well now that you said that, let me just see if I can remember my f-ing room conjuring spell that I learned when I spent my semester at Hogwarts and just make one for you.
So after all the to-do we skip some people to accommodate abdominal pain princess and her knight in shining armor here,  and I walk her back.  The nurse is busy and I'm not at this point in the night, so I decide to help out and start her IV.  Not being in the waiting room seems to already be improving the symptoms drastically, so I'm talking with them about their baby and stuff when she starts making some hilarious baby faces and patient mentions that she thinks the baby might be pooping and baby daddy will have to change her diaper.  At that point, dude gets totally butt hurt and is all like, "Um, NO.  I changed the last one, it's your turn."
OH.  Oh really? Ten minutes ago, you were totally for sure that your baby's mom was legit DYING in the waiting room, but now all of a sudden you're not concerned enough to change your kid's diaper because it's HER TURN? Really? Yeah, all staff be advised, there's now an active douche alert in this room.

Monday, October 15, 2012

Chief Complaints of the Nights

Ugh, sorry I never post anything anymore.  I guess there was some memo sent around that I didn't get about how I've been banned from actually taking care of patients or something, because I am ALWAYS triage or charge.  Unfortunately for you, dear readers, me walking around like an idiot for 12 hours yelling at my phone for ringing so much and trying to sort through my own notes about transfers and dealing with complaints from people about how we haven't fed them when they've been in the ER for three whole hours doesn't make for interesting blogging.  However, the parade of foolishness that is triage is still amusing if you don't think too hard about the reality that these people are out there, driving cars and reproducing.  Sooo here's the highlights this week:

-The guy who checked in for a prescription refill for Naproxen.  Which you can buy over the counter.
-Geriatric patient who came in DRUNK OFF HIS ASS at 4 AM for an insect bite that was most definitely not there, and then proceeded to hit on me in front of his much younger female companion.
-The lady who checked in because she was at "the age when you're supposed to get a colonoscopy".
-The lady that came in with her toddler to get the kid checked after she caught him chewing on the toilet brush.
-Guy who burned his face while smoking over the open gas tank of a running lawn mower who also hit on me, because winners.
-Concerned parent who brought in her two kids that got higher than they were used to after smoking some weed that was more potent than their usual.  I can usually keep a straight face through anything, but when questions about medical history were answered with "man, I really want some meatloaf" I completely lost my shit laughing. Relax, I then reassured mom in a very professional and therapeutic manner that no one has ever OD'd on marijuana and it was going to be okay.
-Oh, I almost forgot the guy that told us there were multi-colored bugs coming out of his butthole that jumped around and layed eggs all over the house.  YUP.
So basically this the entire shift for the last three shifts.  I can't deal with this much longer, so I'm thinking about trying to phase out my own position entirely and maybe replace it with something like this:
with all the staffing cuts, it's only a matter of time.

Tuesday, October 9, 2012

2 weeks

Yup.  It's happening.  I gave Hood Hospital my notice this week, and I'll be starting a new job soon.  I'll still be an ER nurse, and it's pretty close by, so the stuff I see will be somewhat similar, but just less crazy.  New hospital sees a little less people, but it's also run waaay more efficiently. The most amazing part of all- ER BFF is going with me. Apparently when you work in the most ghetto, batshit crazy ER in the city, it's pretty easy to get hired on wherever because they know you can hang.
I'm beyond excited.  I'm sleeping a lot better, and even when shifts at Hood Hospital are shitty, I can at least tell myself that I'll be out of here soon.  It's gonna suck to leave my friends, but I'm so afraid that if I stay here any longer that it could potentially ruin nursing for me forever.  I'm watching people that have stepped up into the roles that I've stepped up to before me- people that I know are amazing nurses, but who have lost a lot of the love for what they do.  This place has taken everything they have.  Before I could see my way out, back when I was still trying to figure out what to do, I would seriously just sit up and cry for absolutely no reason I could identify.  I was a complete and total basket case a month ago, and I pretty much made life impossible for my poor husband.  I know things where I'm going aren't going to be perfect, but I really don't think that I have to settle for a job that's so toxic.
We'll see how it goes.  I'm just relieved I have someone here with me who is going to be going through the same adjustments and growing pains that I am.  I think part of the reason I stayed so long was oddly how horrible it was for me there as a new nurse.  I know the situation was different, but it was really tough being new and isolated and being shy and weird to boot.  I've honestly been a little scared of having to go somewhere new and start fresh with all new people that don't know my quirks and such. Even if this place is staffed with 100 percent total princess Bs, I at least know I have one friend.
The funny thing about all of it is that we're among several people who have jumped ship in the last couple of months.  They've lost nearly a quarter of the staff here recently, and it's finally, finally, caught the attention of the bigwigs.   Despite being told this for multiple YEARS, these idiots are all of a sudden all "OMGZ, you mean you guys don't like running this place with half the staff you're supposed to have and never eating or peeing, and that comparable places with more staff get more shit done and have happier patients? Well OKEY DOKEY then, let's get you a bunch of new staff!"  Except...yeah... the amount they're hiring will only serve to replace the experienced staff that left, so..yeah.
But you know what?  It doesn't matter anymore.  They can make all the promises they want, because I know they're full of crap, and I don't have to take it anymore.   It's a pretty great feeling.