Friday, February 12, 2010

Pink Elephants

Me: (after taking a 190/114 blood pressure) "Oh, wow. Do you usually run this high?"

Patient: "No, I'm not high. Though this one time, back in 1967, I did some crazy shit. Seriously crazy. I saw pink elephants. You've never seen pink elephants until you've done the shit that I did. Have you ever seen pink elephants?"

Me: "... no. But I said that your blood pressure is high. Do you have a history of high blood pressure?"

Patient: "Oh! Oh. Yes, I do." (laughs nervously)


Wednesday, February 10, 2010

Mock Schedule

Yesterday, my charge nurse asked me to create a nurse's aide schedule for the 3 to 11 shift that they could use to teach new hires. I made up a simple one that turned out really boring. It was all, "Vital signs between 1500 and 1600, blood sugars at 1600, set up patients for dinner at 1700" and etc. Basically Yawn McYawn, hailing from the town of Yawnsville in the country of Yawn. I couldn't stand it. It wasn't even true.

That's when it hit me.

It wasn't even true.

Here is my real schedule... enjoy.

2:45pm: Arrive in the break room. Deposit dinner in fridge. Query the previous shift on whether it was a good day or a bad day.
2:50pm: Help self to a cup of water and write name on it. There won’t be time to hydrate once the shift starts.
2:55pm: Accept assignment from the charge nurse. Fill out patient sheet with information.
3:05pm: Search frantically for free blood pressure machines so that blood pressures won’t have to be done manually. Curse Aide #2 and #3, who have commandeered the good ones.
3:10pm: Begin taking vital signs on Patient #1 out of 10.
3:11pm: Call bell sounds. Answer it. Patient #4 asks for covers to be straightened.
3:20pm: Return to taking vital signs. Now on Patient #2 out of 10.
3:21pm: Call bell sounds. Answer it. Patient #8 would like a cup of ice. Fetch cup of ice.
3:40pm: Return to taking vital signs. Finish with Patient #3, #4, and #5 out of 10.
3:49pm: Call bell sounds. Ignore call bell and continue taking vital signs. Finish with Patient #6 out of 10.
4:01pm: Be accosted by Nurse #2 demanding to know why the 4pm blood sugars aren’t done.
4:10pm: Finish vital signs on Patient #7.
4:20pm: Finish vital signs on Patient #8.
4:30pm: Finish vital signs on Patient #9. Patient #9 needs her diaper changed.
4:50pm: Leave room scarred for life by the amount of diarrhea one elderly lady can produce. Give up on final vital signs and begin blood sugars.
4:51pm: Realize machine needs to have quality controls done because the night shift neglected to do it earlier.
4:55pm: Rush to complete blood sugars before dinner arrives.
5:06pm: Dinner arrives.
5:11pm: Last blood sugar is completed.
5:12pm: Interrupt Patient #10's dinner to take vital signs.
5:25pm: Note that five out of ten patients are incapable of sitting up for dinner and must be helped.
5:55pm: Finish setting up every patient for dinner. Pause to take a sip of water. Call bell sounds.
5:06pm: Answer call bell. Patient #8 has slid to the bottom of the bed and needs to be repositioned.
5:07pm: Search for Aide #2 to help in repositioning.
5:12pm: Learn that Aide #2 has taken a smoke break and is unavailable.
5:14pm: Request Nurse #3's help in repositioning.
5:15pm: Get denied by Nurse #3 because Aide #2 should help.
5:20pm: Find Nurse #4, who does not have Patient #8, but is willing to assist.
5:25pm: Finish repositioning patient and remove tray.
5:26pm: Round floor searching for dietary cart.
5:32pm: Assume that the cart has been removed.
5:40pm: Give up and go to place tray in Soiled Utility Room despite blatant sign.
5:42pm: Open door only to have it slam into the dietary cart three inches away. Drop tray and dump spaghetti over self.
5:45pm: Alert Martin (housekeeper) to the mess. Martin is not amused.
6:05pm: Return to floor in new scrubs. Rush to take a 6pm blood sugar.
6:15pm: Circle floor and update charts on ingestion and excretion, including meal percentages. Receive basic report from nurses on the patients that have been cared for, by you, for the past three hours.
6:30pm: Take dinner break. Get interrupted by nurses three times with requested tasks "for when you're finished".
7:00pm: Return to floor and check updated assignment. Nurse #2 has left, replaced by Nurse #3, and an aide has gone home sick. Pick up 4 additional patients for a total of 14.
7:10pm: Answer call bell. Patient #4 needs to be walked to the bathroom.
7:20pm: Answer call bell. Nurse #3 needs help coaxing Patient #9 back into bed.
7:32pm: Fetch bed alarm for Patient #9.
7:45pm: Assist Aide #2 in changing a 400 lb patient who does not bathe regularly.
8:15pm: Check blood pressure on Patient #1 to find it 65 over 30. Search for Nurse #3.
8:21pm: Fetch Nurse #3 to Patient #1.
8:25pm: Answer call bell. Patient #5 will be discharged and needs personal items packed.
8:27pm: Finish packing personal items.
8:50pm: Finish listening to Patient #5's stories about the war.
8:51pm: Begin 9pm blood sugars.
9:01pm: Get accosted by Nurse #3 demanding blood sugars.
9:18pm: Finish blood sugars.
9:21pm: Take a water break. Breathe.
9:24pm: Answer call bell. Patient #10 would like a snack.
9:30pm: Deliver snack. Patient #10 would also like a blanket.
9:36pm: Deliver blanket. In addition, Patient #10 would like help with the urinal.
9:45pm: Patient #10 requests marital status.
9:46pm: Patient #10 is denied.
10:07pm: All patients’ charts are updated, completed, and handed in to the charge nurse.
10:11pm: Patients are quiet. Nurses are busy. Lower self into chair.
10:12pm: Call bell sounds.
10:13pm: Answer call bell. Patient #6 requests Nurse #2.
10:15pm: Check desk for Nurse #2.
10:17pm: Check med room for Nurse #2.
10:19pm: Check supply room for Nurse #2.
10:22pm: Check hallways for Nurse #2.
10:23pm: Ask the desk if anyone has seen Nurse #2. Predictably, no one has.
10:24pm: Call bell sounds. Answer call bell for Patient #6, who demands to know where Nurse #2 is.
10:36pm: Discover Nurse #2 in break room. Inform her of Patient #6.
10:40pm: Empty catheter of Patient #2. Accidentally wake him and listen to him say he wants to die.
10:45pm: Comfort Patient #2 and reassure him that no, he does not. He argues and makes valid points you must not refute.
10:53pm: Back out of Patient #2's room, slowly.
10:59pm: Plop into chair in break room. Breathe sigh of relief. Respond incoherently when asked by next shift how the night went.
11:01pm: Call bell sounds. Call bell is ignored by both the departing and the arriving shifts.
11:02pm: Run like a bat out of hell!

Tuesday, February 9, 2010

My First Code

Finally, finally, finally. After working at a hospital for ten and a half months, I have witnessed my first code.

Every other time before when the monitor tech paged a "Code zero room so-and-so," I've been trapped in a room somewhere. One time, we had three separate codes on my floor and I missed them because I just so happened to have been sent to ICU for those four hours. Where no one had the decency to code, I might add.

So this time, I was really and truly excited. No patients needed my attention. I wasn't on the wrong floor. When they called "Code zero room 324," I dashed in there as fast as my little legs could carry me.

The patient was a 60-year-old male with various extensive health problems, including diabetes, MRSA wounds, kidney failure, and on and on. The nurse had told me that he lived in the nursing home across the hall from his 85-year-old father. How sad is that?

Anyway, I was standing there agog as two nurses took turns doing chest compressions. Then suddenly the doctor was there, and anesthesia, and four more nurses, and the other nurse's aide on the floor, and we all worked on him. They shot him full of fluids and epinephrine, but the poor guy was just not destined to make it. We worked for a solid half hour to establish normal sinus rhythm and a firm, solid pulse with no luck. We would get a strong pulse.... only to have it slip away. He would go into vtach and we would shock him... only for him to lose it again.

Throughout the whole thing, I was excited rather than disturbed. I gathered the courage to do chest compressions and pumped on his chest for four or five minutes before I needed a break. It's astounding to think that you have the power to keep someone closer to life than to death just by doing that.

After that half hour, the doctor called it and everyone settled back. One of the weirdest but most heartening things was how the relief shone through in that moment. Everyone knew they had given their best, and it hadn't been enough, but they were all cracking jokes as we cleaned up the room. They all kept asking me if I was okay, and I would tell them, "Just fine." It hadn't disturbed me at all. Maybe this was because the patient wasn't one I had taken care of before? Maybe I am just a cold-hearted bitch? I'm not sure.

Now I look forward (not really, but you know what I mean) to a code on a patient I know so that I can see how I react.

Sunday, February 7, 2010

What is it with me and catheters?

Me: "Listen. The catheter has to stay in. It's draining your urine. You can't pull it out."

Stuck-Up Old Woman: "Actually, I was trying to pick it out. Shows what you know."


7p to 7a for the WIN

I have been working nonstop the past week because I am determined to buy the iPad. Today, it's a 12 hour shift that is completely overtime. (Woohoo!)

7p to 7a is about the easiest 12 hour shift you can do because of a couple things:

Number one, you only have to do vital signs once.

Number two, your people are asleep half the time.

Number three, it starts harder and gets easier.

I have 17 patients at this exact moment in time and no bells have gone off for two full hours.

Ahhh. That beautiful sound that is silence.