Don't they know it's Christmas aatt alll.....

In my inbox this morning:

Hood Hospital weekly huddle up gather round circle jerk!

Hey nurses! Great job on being totally awesome and getting us stroke certified! So, you know how you guys did that education and only got payed for half of it because you're our bitches and we threatened and intimidated you? Well, not only did you do that, but you also voluntarily remembered some information and were able to recite it to some people with money, so great job! Way to go! Pat yourselves on the back!

Oh. B-T- Dubs, even though we'll be getting like, lots more money because of that stroke certification you worked so hard to get, we're eliminating all bonus and cutting down strictly on overtime during the busiest time of year. Yeah, we figured since you aren't getting a Christmas bonus we might as well get you something, and that something is a figurative ass raping with no lube. We'll be thinking of you and your atrociously understaffed coworkers in this most special of seasons, while we watch our eight year olds open the Ipads we bought with the money we saved on your overtime pay. Yes, we truly hold you dear in our hearts when we attempt to fill the void where our souls once were with 20 dollar mimosas. We think about the verbal and physical assault you will most surely endure when the inevitable 6 hour average wait times return to your ED because you don't have enough nurses available to take care of the patients. We sincerely mean it when we say we couldn't stick it to you so hard if you didn't take it. Thanks for all that you do.

Happy Holidays!

Sincerely, Hood Hospital upper management

Holy crap guys. 2 glasses of wine hasn't killed the rage yet. Should I go for 3?

Hood Nurse, shaping the future of nursing

OMG, guys. Someone was smoking the wrong stuff and decided to send a shiny new nurse extern along with me so I could show him the ropes yesterday. Poor guy. I think it was my by default since I came in a few hours early and was the only night nurse there when he showed up. It totally solidified in my mind the fact that I am in no way, shape or form prepared to teach anyone anything- I was trying to show him how stuff in the ER works and just let him get some experience whilst trying to deal with my regular shit magnet assignment, and I kept losing the poor kid because I was practically running back and forth from the doctor's station to the omnicell to patients rooms and back for about 3 hours straight. On the bright side, my terrible luck probably made for an exciting introduction the the ED for him- we got a spontaneous pneumohemothorax, fake catonic state vs. possible dystonic reaction, pneumonia, hypertensive crisis, and a rollover MVC with a giant head laceration who kept passing out in just the first couple of hours.

I tried take advantage of teachable moments, but most of my education went something like, "Okay, new extern. Go into room 15 and listen to that lady's lung sounds so you can know the difference between regular wheezing and 'oh shit' wheezing. She sounds like total hell, so we're gonna give her some steroids and breathing treatments." Hot mess. He got to work on some assessment opportunities and some IV starts, and we figured out the order system, but I just felt so bad that he was stuck with someone as disorganized as scatterbrained as myself.

He couldn't have been nicer, either- he actually gave me a hug at the end of my shift and seemed genuinely disappointed that I wasn't going to be there with him the next shift- I hope they can pair him with someone that can actually get their thoughts together long enough to explain what they're doing, because I sure wasn't that person last night.

Sometimes when I'm having my on days I think to myself, "Wow, I'm like an experienced, grown up nurse now." Yeah, not so much. Trying to teach someone else really solidified the fact that I still have some growing up to do. Good luck you, new extern.

"I have worms in my brain"

You have no idea how many times in my career I have seen complaints like this. And usually the culprit is the same- the crazy. So imagine my surprise last night when my friend hands me the chart for my new patient and just says "brain worms". Shut up. I have had enough psych patients to last me a lifetime, thanks a lot. No. For real real. This lady had MFin' worms in her brain, y'all. Neurocysticercosis, which until I met this woman, I had no idea existed. This is just a little bit worse than her CT.

I DID NOT learn about this is nursing school, because I would have remembered and had nightmares about brain worms. Apparently, it's not uncommon in less developed nations- most people get it through undercooked infected pork or food that's been exposed to infected meat or people. This poor lady had just come in for headaches from hell and- surprise!- at one time or currently, was hosting these delightful creatures in her brain tissue. Eeee. Another addition to my list of phobias.

You are so dumb, for real

The bedroom intruder app has taken the hood hospital's night shift by storm. For anyone not familiar, it's a collection of sound clips from a rather popular viral video that you can see here.

Let me just tell you that this weekend, we got extra use out of one particular part with all the foolish, foolish things we saw.

As usual, there is the always reliable material from triage. I think my favorite complaint had to have been the guy who checked in because he's been walking a lot and he had two blisters on his foot. You came to the ER for that? Seriously? You are really, really dumb.

And how about one of my fellow employees from a department that is not mine and will not be named, who during a stroke forum, asked if we were going to give TPA for hemmorhagic strokes. Wha wah. I won't even say it.

The winner this week by far has been the surrounding nursing homes, though. Long term critical care hospital sent over a guy being treated long term for sepsis with low O2 sats- amazingly enough, they called and gave us report, telling us he had been febrile and couldn't maintain his sats even on 100% oxygen on a non-rebreather mask. Since we start oxygen at 2 liters through a cannula and work up to a non-rebreather, which requires around 15 liters to work properly, we figured this guy was gonna be in pretty bad shape. To our surprise, he came to us okay looking with normal vitals. The medics that brought him in told us that they apparently walked in to pick him up and found him lying flat, wearing a non rebreather mask with O2 going at 5 liters a minute. Well. I think you found your problem, which is, you're dumb.
This wasn't even close to the worst- we also got an EMS transfer at 11PM on a weekend for- I can't believe I'm saying this- mold in the PEG tube. Yup. Apparently mold grows very quickly, like over a matter of hours, and is very dangerous once it appears in the PEG tube that you no longer use and clearly, no longer flush. Definitely a situation where an ambulance needs to be called.
The best still, I believe, was the poor little lady they sent over for, as they put it on the transfer sheet "excessive bleeding to the Virginia". And while I would be concerned if my patient's virginia was bleeding also, the situation apparently resulted when for whatever reason, they were trying to catheterize this little lady (and I'm willing to bet, were doing it wrong) and noticed some blood after several attempts. They called the medics, who brought her to us- the doctor did an exam to find everything in order and perfectly normal, other than a tiny spot of blood in the diaper. Yup, I had to call them back on that one. Nursing home, you are really dumb, for real. Stop sending us stupid transfers. We gonna find you.

Let me tell you how to do it right

I mean, seriously. If you're gonna fake a syncopal episode in the waiting room and commit to lying on the nasty ass hospital floor, you probably shouldn't reach into your pocket with your eyes still closed and pull out your wallet when the nurse asks for your ID so she can check you in. Nurses are trained in these things and we know you cannot respond to verbal commands while passed out, so you are not going to trick us. Instead, we will just tell you very quietly that you better stand up right now before we get the ammonia poppers. Please practice at home and try again the next time you come, which I'm sure you will, thanks.

Shit magnet

Yes, I will officially take my title now. Unfortunately, my friend who charged the extra shift I picked up last night also shares the same honor, so we were screwed from the start. My patient load when I walk in- little old granny with blood glucose of 700 and a thousand family members with the collective IQ of a brick who want everything just so, lady with mentation from crazy town withdrawing from benzos trying to climb out of bed, sweating profusely and making Frankenstein noises, and teenage "suicide attempt" with 5 Aspirin who absolutely refused to drink her activated charcoal. Well, of course we had to have about 7 staff members climb on top of her while her stupid ass tried to bite us and we crammed and NG tube and a bunch of charcoal down her nose hole. And of course we had no rooms so these people were admitted and I was stuck with them all night, and naturally granny had to be turned and have boo boo cleaned and have an apple juice and have blood sugars checked every 20 minutes but you can't do it on that finger, or that finger, and if she wasn't perfectly symmetrical lying in the bed I knew about it.

I had her long enough that I had to try and start her admission assessment, and with every new question found out about a new medical problem that we didn't know about before, but no one knew when or how it was treated and what it was called, and the daughter was trying to give me her very limited knowledge of her mothers medical information while at the same time screaming at some poor police officer on the phone about how her car was stolen. My relatively simple constipation via EMS most definitely turned out to not only have a massive bowel obstruction requiring surgery, but she also was in renal failure. FML.

So this morning over beers, we had this conversation.

Me: Yeah, you need to find some safe place to put me where the train wreck crazy patients won't find me.

Charge nurse buddy: Yeah, like your house.

Well, yeah, it's probably the only way. Could you go ahead and pay me though?

That's a new one

During a discharge for a simple laceration repair-

Me: Okay, so here's your prescriptions, just keep that clean and dry and elevated until you can follow up with the doctor.

Patient:Where is that doctor's number again?

Me: Oh, right on this second page of your discharge papers.

Patient: And where can I get your phone number?

Me: Buddy, I'm gonna need you to stop.

Well, there you go guys. New ER pick up line.

Haunted

It's been a month and a half and I still can't shake the guilt and sadness of a patient dying under my care. Surprisingly, the process of dying is not something we see very often in the ER. We see lots of CPRs in progress, but to put it quite frankly, these people are already dead. They don't talk to us. They don't move or blink their eyes. We never saw them smile or interact with their families or heard them say thank you. They lie there while we try to revive them, and it almost never works.

When we do see death like this, it's not in people who are ready for it. This man was no different. He had not been given a terminal diagnosis or an amount of time he was supposed to live. He was older but healthy- he looked much younger than his 70 years. He came to the ER because he was feeling weak. He walked up to the desk and checked in without a fuss. When the triage nurse took his blood pressure, it was 68/40.

I could tell immediately by looking at him that he was very sick. We were able to establish a couple of IVs on him and we gave him some fluids. He said he felt better, but he was very tired. His blood pressure was rising, but not a lot. He really seemed to be doing better. His sweet wife gave him a kiss and ran down the street to get him some clothing and his meds from home when we told her we would be admitting him. When she left, I stayed with him, and something frightening started to happen. He would fall asleep, but his breathing would slow and his oxygen saturation would start to drop. I stayed with him for about a half hour straight. He would fall asleep and I would call his name and shake him awake. "Mister, mister", I said to him, "Are you okay? Are you still with me? Please stay with me." He would open his eyes and say, "I'm with you. I'm feeling better." I was so frightened for him. At this point I just had to step out of the room for 5 minutes to go to the bathroom- I grabbed one of our nurses who was floating to stay with him. I just told her to watch him very close, that I was very worried about him. When I came back a few minutes later, he was breathing with snoring respirations, and his wife had showed up at the same time as me to see the other staff panicking and pushing his bed into a trauma room.

She burst into tears and I got her a chair to sit in and gave her a hug. I told her very hastily that we were going to help the doctor with a sterile procedure and that afterwards she could come in a be with him. It all happened so fast after that. We put in a central line and an arterial line, I learned how to use the arterial line, we started more fluids and vasopressors. We get his blood pressure half way decent, but he's becoming less responsive so we have to intubate him. We get his tests results back and his troponin is through the roof- chances are, he's had or having a massive heart attack and is going into cardiogenic shock. He's not stable enough for any type of intervention, but I start a heparin drip in addition to the blood pressure meds to try and bust up any kind of blockage that may be happening in the heart. I get a second and I'm able to talk to his wife and niece and her husband. They never had children, but they are very close with their niece. They all filter in and out, trying to be there for him but give us space to work.

Despite everything, his blood pressure starts to drop again. I start two more vasopressors and quickly bump them all to their maximum dose. We get the doctor in and she talks to the wife about the fact that not many options are left. She agrees to stick to the vasopressors but decides she doesn't want us to do CPR when the time comes. It comes slowly. The blood pressure stops reading. The heart rate drops. I go to get his wife but she can't bear to watch. She came in a little while after his heart finally stopped. She took his hand and wept and whispered his name. "What am I going to do without you?", she asked him. I wondered, too.

My grandfather died a few months before this happened. He suffered from Alzheimer's for years. We got a chance to say goodbye, but it doesn't make it much easier. Suddenly I'll be surprised by something that makes me think of him and I'm reminded of just how much I miss him.

When I think of him, I often think of this family, too. How much his wife must have hurt on her first Thanksgiving without her husband. About how the reminders must sneak up and hurt her, too.

After she left his room and I was running amok trying get things in order, I walked by her crying outside his room. I walked up and hugged her, unsuccessfully fighting tears. "I'm so sorry," I told her, " If only I could have done something more." I will always remember what she said to me. Even in her moment of grief, she hugged me and said, "No baby. You did a great job. It was just his time. God was ready, but we weren't."

I can't completely explain why, but this particular thing has just shaken me to my core. I don't know whether it's own experiences at the time or just how unfair the whole thing felt. I always look up the other ER visits when I go to call the medical examiner, and it was obvious just by looking at his visits that this man took care of himself. He went to the doctor and did what he was supposed to do. It was clear from the short time that I had to interact with the patient and his wife that they were very sweet- the kind of people you feel blessed to take care of. The kind that remind you why you do what you do. And I guess even with the outcome, I do feel blessed to have taken care of them. I just wish they could have gotten something different.

Warped

Every day I find new and different ways that this job his warped my mind.

Recently, I've taken up running after developing an intense case of muffin top in literally every pair of jeans I own, which with asthma and general laziness has been a bit of a challenge for me.

I had a particularly challenging morning the other day, when I decided to get beer and tacos after work but then decided to fun afterwards because I felt guilty (dear readers, never do this).

Well, after about a mile I stopped to get a drink of water and threw up a little. Then I got really dizzy and kind of felt like passing out.

Instead of thinking what any normal person might have, the only thing going through my head was, "Dude, I am not having a syncopal episode out here. I've been running and working a 12 and I smell like hell. These underwear are gross. If EMS shows up here and I wake up I am refusing the hell out of transport."

I think something is wrong with me.