Saturday, March 26, 2011


Thursday was so lucky! I started the shift with my patient's wife frantically telling me we had lost her husband's iPhone. "When I left last night, it was in his front pocket and now it's gone!" Remembering the night nurse had changed his sheets and gown during the night, I looked in his laundry bin--easy. But it was empty. No problem, I could just look in the units' laundry room--just a few different bags, on biggie. But it was empty. Panicking, I called the laundry room for the whole hospital, warning them I was going to have to come look through the whole hospital's last 24 hours' worth of laundry to find this iPhone. I even gave report to my charge nurse, thinking it was going to take hours. I asked the wife the pt's number, just in case maybe it was on and the sound could help guide us. Down in the laundry room, there were about 100 bags of linen. Then they opened up the chute that had last night's laundry. About 50 more bags piled out. I was laughing so hard--mostly to keep myself from crying. "Well, let's get to work," I said to the laundry worker helping me. But first, I thought I would try calling the number, jsut to see. And I felt a vibration on my foot...I ripped open the bag right at my feet. And sure enough, there it was! My first thought was, "Jesus loves me!" (quoting my freshman roommate).

P. S. A few hours later, that patient spiked a fever of 107! Can you believe that?! I couldn't, so I tried 3 different thermometers. Sure enough: 107.4. Crazy--I about had a stroke!

Thursday, March 10, 2011

"tender mercies"

Today my patient passed away. She was very sick and had a poor prognosis. To keep treating her would have only prolonged suffering. But stopping treatment is always unsettling for me. Just the fact that I have some kind of responsibility in the death leaves me with a lump in my throat. 
However, today I felt like the Lord sent some "tender mercies" to help.
First of all, she was a wonderful woman. Raised a few beautiful daughters. Then when one of the daughters passed away, she raised her 2 orphaned grand-daughters. According to her sisters, she was the one always helping their mom when she was sick. She had a sweet disposition. Each member of her family knew she loved them.
Second, our chaplain was there. She carried the family (and me!) through the day with her calm and reassuring words.
Third, she was comfortable the whole time. Granted, she was getting dilaudid every hour. But she didn't get that agonizing breathing or the anxious look. The family commented more than once on how little pain they saw in her.
And finally, the look on her face in the end. It sounds cheesy, maybe even morbid. But her face was the calmest I've ever seen someone so soon after passing, almost a smile--eyes and mouth closed. She was beautiful, honestly. I might be linking emotions/spirituality with work too much again, but I felt like her peaceful expression was the Lord's way of letting me know she was happy and the right thing had been done.

Tuesday, March 8, 2011

One of Two

There were two experiences I had that made me really want to start this blog. They impacted me so much--not just my nursing, but me as a person. I wanted to write them where I could remember them. So here's one.
All our patients are different, of course. They all have their own stories, their own personalities, and even their own responses to treatment. However, they all kind of fall into "groups." Elder people whose bodies can't fight another infection, so they go septic; college age overdoses; middle-aged MIs; teenage DKAs; older people who get vascular surgery (and for some reason almost always happen to be frequent drinkers who go into DTs while on our unit...). These are all so sad. I ache for all of them. But they start to blend together.
But in January I had one patient who totally stood out. She was a young girl, late twenties. She had been married 5-6 years and hadn't been able to have kids due to endometriosis. They had tried all kinds of infertility treatment, etc., with no results. Finally, they decided to try in-vitro. Her doctors strongly advised against it. But she wanted so much to have her own child and went ahead with it. After twenty-one very painful weeks of pregnancy, she came in to the ER bleeding. They admitted her for observation. A couple days later, her uterus ruptured. They took her to emergency surgery. She lost her baby and her uterus, and became septic. She came to our ICU on the ventilator and pressors, in an induced coma. I had her two days after. Right as I came on shift, lab called with more lab results--more infections found in her blood. We would have to change out all her IV lines, A-line, CVP, etc. and start a new regimen of antibiotics.
I had only been on my own for three weeks. I should have been terrified. But, for what seemed like the first time, I was so concerned and concentrated on the patient, I didn't have time to think about it. I just went to work, doing all I could.
The next two days were a blur--two of the busiest I've had. And emotional. Every time I told her story to a new doctor on the case or gave report to the new nurses, I cried. I couldn't help it.
But I think the reason I will never forget that patient is because of the feeling in the room. It was so wholesome. I spent a lot of time talking with her sweet, supportive husband. He would bring his IPOD and play hymns and christian music in her ears. He asked questions about her condition, but never questioned the outcome. Faith, I guess is what it was.
I also spent a lot of time talking to her grandma and her aunts (one of which is a housekeeper on our unit). They were everything you could hope for to support a girl who had gone through what she had. They were so supportive--listening and staying by the bedside for hours and hours. Crying, but laughing, too. And lots of praying. And every time I left the room they would say to me, "Thank you, Mija."
When I came home the second night of being her nurse, I thought for the first time about how tired I was and how inadequate I must have been for the job. But it didn't hit me until then. I spent the rest of the day just caught up in the hope the family carried with them.
Maybe this all sounds cheesy. Maybe I interlock emotions, spiritual things, and work too much. But it was a testimony builder to me of the Lord's support for those who are trying. I know the Spirit was there in that room all the time and gave it that wholesome, hopeful feeling. And I know--I knew it the whole time I took care of her--that the Lord knew exactly what she was going through and was going to pull her and her famliy through, as hard as it would be.
It's not often my testimony is built at work. It was in this case. I guess that's why I wanted so much to write about it.

As far as how she did, she stayed in a coma another few days, then was extubated and woke up. Those were the hardest days, according to the other nurses and the family. That was when it sunk in and she began mourning. She left our unit healing very well physically and starting therapy to work through her emotions. Her family was sad, but very hopeful as she began the process.

Friday, March 4, 2011

what makes long days durable

I sat down to enter doctors' orders into the computer yesterday only to find my computer screen upside down. I kind of tilted my head and tried to get my barrings, then heard snickering the next pod over. Our unit secretary (tied with one of the PCTs for the ultimate prankster) was peaking around the corner laughing at me. We spent the rest of the day laughing at doctors' reactions to the upside down screens as they sat down to check patients' charts. Our favorite was the one who turned the whole computer upside down. We're so lucky it didn't break!
P.S. In case you need this kind of entertainment where you work, just press control-alt-down arrow and see how confused your co-workers get. (and sorry--it only works on dell)

Wednesday, March 2, 2011

the "typical" day

0700: Report from night shift.
0800: assessment. I've given up on the head-to-toe thing. I'm a little ADD for that. I've resorted to "around the bed".
0900: meds. sounds so simple--and it should be! Yet it still takes me so much time. checking and rechecking the MAR. Drawing up the right doses, crushing the pills, getting another nurse to check my heparin/insulin/narc gtts, gathering the syringes/needles/infusion pumps/alcohol wipes/etc. etc. For two patients, it often takes me over an hour!
1000: turning patients. hopefully there's a tech available to help boost, check skin, clean surprises. trach care, dressing changes, bath, oral care, etc etc. The doctors are also coming in at this point. So, through the curtain comes "what was his potassium today? did we replace it? how long has the versed been off? where is the levo? has he had an echo done?" and through my mask and the curtain, as I'm packing sterile guaze between staples in the abdomen, "3.3 and yes. 4am--still no response to verbal stimuli. 8mcg--going down. i don't know." (I'm coming to terms with that last answer.  it's very often the sad but honest truth.)
1100: more doctors. more questions. more "i don't know"s. and more orders.
1130: assessment again.
1200: meds.
1300: entering the doctor's orders.
1400: I open my paperwork. aaahhhhhh! Seriously? all blank? maybe I'll go to lunch instead...
1430: back from lunch. open my paperwork. really? still blank. maybe I'll talk to my pod-partner for just a little bit...
1500: open my paperwork. Blank? I could have sworn I started something! I start scribbling....
1600: assessments again. last one. phew. and meds.
1700: more charting, and some late doctors straggling through.
1800: more meds. empty drains, I/Os, clear pumps, clean rooms, etc.
1900: night shift here! Report.
Mixed in with that is the q2 hr oral care/patient repositioning/restraint check, hourly vitals, the line for the pyxis, waiting for the facilities guy to come fix the pyxis after it's broken down for the 8th time today, answering family member's questions, helping my pod-mate with his/her patients, and the phone calls! oh the phone calls! and, what i didn't understand until I was a nurse, there's always the unofficial assessment. his heart-rate is up--why? should I call the doc? what meds can I give for that? he's not peeing as much as he was--why? she seems more confuse than before. I wonder what her paCO2 is. that's racing through my mind all the time...
even on easy days, I still feel pretty tired by the end!

my first day

Even though it's been six months, i think my first post should still be about my first day. This is an email I sent my parents the next day:
As for my job, my first day was kind of baptism by fire. The first thing the previous nurse said when giving us report was, "I can't believe this patient is still alive." And after report and assessing the patient, I couldn't believe he was either. Even in the middle of report his blood pressure dropped to 60/40, so we upped our norepinephrine until it we had maxed out the dosage. That meant he was maxed out on norepinephrine, vasopressin, and phenylephrine. As soon as report was over, we and the doctors explained to the family that the patient was not doing very well and that it would be wise to consider just comfort measures. However, they said if there was even the slightest chance of the patient living, they wanted to do everything possible. It was hard to be in on that conversation--understanding how much the family must hope for him to live, but seeing how unlikely that was. So, we knew in order to help him, we needed to get him started on continuous dialysis. But we didn't have a vas cath to do so. Our intensivist came to put another one in. About half way through putting in the vas cath, the patient's pressure started dropping again so we started a fourth pressor, epinephrine. That held for a bit. So we scrambled--my preceptor, Lourdes, was setting up the continuous dialysis while I got antibiotics (the patient was badly septic), diuretics, albumin, etc. going. In the midst of all this, he was holding his pressure 60/40, not ideal but we were ok with it. Then all the sudden, after not looking at the monitor for about fiveminutes, I looked and his pressure was 39/31, maxed out on every pressor we coould give. We got the doctor and the family there. Just as we were about to start the code, the family said they did not want compressions, just a "chemical code". So we began pushing bicarb and Ca gluconate. But the pressure kept dropping and we watched the heart rate go from 150's to 40's. Finally the doctor called it, it was done. The family broke down, Lourdes and I broke down, even the doctor had tears in his eyes. We had worked so hard all morning, just to see this! And to see the family have to watch him go in such a frantic, desperate way. It was really sad and really hard to watch. As a tech, I knew this happened, but I was always spread out over eight-sixteen different patients and wasn't as involved in each. So I was emotional. Then the rest of the family came in. One son was slightly handicapped. He came in and as soon as he saw his dad, he fainted and fell to the floor. Things turned frantic again, waking him up and making sure he was ok. He woke up and went hysterical, screaming and thrashing, etc. It, again, was hard to watch and be so close to that. I broke down again, and sobbed for a while. Not helpful to the family, I'm sure but I couldn't help it! Lourdes told me this was almost as bad as it gets and would probably be uphill from here for me. I was glad to hear that! We stayed with the family, trying to comfort them for another hour or so. Then had a couple of hours of paperwork and getting the patient to the mortuary. Finally, about 3:30 we had a break and caught some lunch. When we got back, we got two new post-op patients, one with a AAA, the other with a bile duct obstruction (he was the color of a squash). So we flew, getting them admitted and getting their pain under control. I went home so tired, physically, mentally and emotionally! I hope I build up some stamina for this! (The next day they blessed me with two telemetry patients, both awake, alert, pleasant and uncomplicated. I still was overwhelmed with how much I needed to learn, but it was a very nice break after the previous day!)

here we go...

This may be a crazy idea. After all, a good percentage of my days at work are spent charting what I've done. Why would I want to come home and chart more? But in my charting at work, I don't get to add the colorful, fun, important, or life-changing things. "pt alert and oriented"--I don't get to add that he laughed at all my jokes and gave me the confidence to get through the next twelve hours. "family at bedside"--I don't get to chart the stories they tell me about their family member: "my husband's parents put him in a shoebox to sleep for the first month of his life." "she was a swimsuit model forty years ago." (k--maybe that's not important, but definitely interesting, considering...)  And "femoral arterial line d/c'd, pressure until hemostasis achieved." I don't talk about how hard I pray the whole fifteen minutes I'm holding pressure that there isn't a huge hematoma underneath or retroperitonel bleeding and that they won't vagal down and that I won't pass out like I did that one time...
Anyway, this is going to be my own chart. I get to write what I want to write, not to protect my license in court, but to process the huge gamot of emotions I feel when I work.