Last week I helped care for a Vietnam vet who had come to our unit with an extremely high blood alcohol level. High enough that most people would be in a coma, or even dead with a level as high as his. He was a chronic heavy drinker, consuming approximately 4+ cases of beer per week. He has end stage liver disease, and because of the DT's he was sure to face and a GI bleed, he was admitted to our unit for close monitoring.
We talked with him about all of his options. He knows he is going to die. He openly told this to us. His wife divorced him, his daughter doesn't speak to him, and he is sure that his liver won't last the amount of time required for him to be "dry" before he could even become eligible for a transplant. He recognizes that he could have done things better, but his feelings on the matter? "If I'm going to die anyway, I might as well keep doing the things I enjoy". At this point, I'm not sure I could blame him for not wanting to quit. Despite the hell he was going through, his cravings for a cigarette and a beer, his hunger from being NPO, and the pain he was in, he had to have been one of the nicest patients I had cared for. Always polite, respectful, and appreciative. I'm not sure I could have been as nice as him if I was feeling only half as crappy.
Today he was readmitted back to the hospital, though not in my unit. His blood alcohol on admission was only around 0.08 or so. I was amazed, and I paid a visit to him during my lunch break. He looked awesome! I couldn't believe it. He just looked healthier and in better spirits. He informed me that he had just had approximately 4 liters of fluid removed from his abdomen. He told me that he was really trying, and is currently down to about 4-5 beers a day. He looked very happy to see me, and told me how much he appreciated me coming to visit him. I think it's important to show people you DO care, and it can be doubly important for someone who doesn't have that family support system and believe that nobody cares about them.
He will have to continue to have fluid drained from his abdomen every 4-6 weeks. I hope he continues to try to improve his health. I wish him all the luck.
September 19, 2011
September 10, 2011
Why I became a nurse
I've been struggling with my desire to share this part of myself versus the difficulty in writing this and the memories it stirs. Ultimately, I think I will share, but I believe I will leave out a few details as it's just a little too painful to talk about.
Growing up, I was my mother's best friend. She had this innocent, child-like soul. Emotionally, I was often more mature and responsible. Not that that was a bad thing. It just was.
She also had many ailments that plagued her. Often “sick”. Now that I know the things that I know, I wonder how much of it was psychiatric in nature. When I was a preteen, my mother suffered an injury that led to her paralysis from the waist down. One that I also now believe was psychiatric in nature. I was her caregiver for many years.
In my late teens, she suffered another injury. A 22 gauge shotgun discharged, with the barrel resting against her chest. Her injuries were extensive. She “died” several times in the first couple of weeks. She spent months in an intensive care unit. I was young, oh so young. I was terrified. I was grieving. I was confused. I was angry. I was a mixed bag of so many emotions I couldn’t even begin to recognize them all.
The nurses in the ICU were absolutely wonderful. Not only did they care for my mother, they cared for me. They were a source of emotional support. They were patient and understanding. I was so thankful for the care they provided us. I was so thankful that there were these wonderful kind souls who were willing to sign on to do all of the undesirable tasks that nursing entails. They were my mother’s lifeline. They were my lifeline.
After many months, my Mother WALKED out of that hospital. It was a miracle in of itself that she survived. How was it even possible that a woman who was paralyzed for 7 years not only survive such horrendous injuries, but regain feeling in her lower extremities and relearn to walk? I never believed in miracles until that day.
Fast forward 5 years. I had made a bit of a mess of my life, but I had finally gotten my shit together. I had some thoughts over the years about what I wanted to do, but finally got to a point in my life where I was able to take action. I enrolled in school to become a nurse. I wanted to do for others what those wonderful nurses did for my mother and me. I wanted to help, I wanted to be a resource for families and patients, I wanted to help people in their time of need.
I became an LPN first. My mother was proud of me, she encouraged me the entire way. She was my motivation. When I started classes part time for my associates degree, she was again proud and my source of motivation. She lived long enough for me to achieve the title “RN”.
That year, her health rapidly declined. Her problems were directly related to complications of her injuries from the gunshot accident. She passed away prior to my making the leap from pediatric homecare to critical care. She was proud of me throughout nursing school, she was proud of me when I worked at the nursing home, she was proud of me when I worked in homecare. I miss her so much it hurts, but I know she is up there smiling down on me, and I know she is proud of me now.
August 29, 2011
First trip to the morgue
Yesterday I helped with the admission of a middle aged woman. She was crying in pain. Specifically her legs, her back, and her head. She had multiple tests done. All came back normal. I felt so helpless and didn't know how to help her.
Today, she went downhill fast. She was actively dying and was a DNR. All we could do was keep her comfortable. Her very large family was all present and stayed with her the entire time. A Catholic priest was called at the request of the family. We all held our breath and prayed that the priest would make it in time. She passed away within a minute of the priest arriving.
After the family left, I helped the nurse's aide wheel her down to the morgue. I must say, seeing it was not like what I expected. Not at all. Just a very small room with a metal table and scale. A walk in cooler that was big enough to fit only 2 stretchers inside. Small hospital, small morgue I guess. What happens if you have to take a patient down there, in the middle of the night, and the cooler already is at capacity? What am I supposed to do with the body? Nobody could answer my question. They all say "Oh, that won't happen".
Murphy's Law: It will happen to me. In the middle of the night. When I'm fresh off of orientation.
Today, she went downhill fast. She was actively dying and was a DNR. All we could do was keep her comfortable. Her very large family was all present and stayed with her the entire time. A Catholic priest was called at the request of the family. We all held our breath and prayed that the priest would make it in time. She passed away within a minute of the priest arriving.
After the family left, I helped the nurse's aide wheel her down to the morgue. I must say, seeing it was not like what I expected. Not at all. Just a very small room with a metal table and scale. A walk in cooler that was big enough to fit only 2 stretchers inside. Small hospital, small morgue I guess. What happens if you have to take a patient down there, in the middle of the night, and the cooler already is at capacity? What am I supposed to do with the body? Nobody could answer my question. They all say "Oh, that won't happen".
Murphy's Law: It will happen to me. In the middle of the night. When I'm fresh off of orientation.
August 22, 2011
Dr. Dolittle
I'm sensing a theme in the unit. There is one doctor in particular who nobody wants to call, and who everybody avoids at all costs. I hear repeatedly from different people in my unit, in other units, and in other disciplines, how this doctor never does anything for his patients, and when he does, his orders are outrageously unsafe. I'm fearful that my meek, mild personality won't cut it when the day comes that I have to deal with this doctor.
August 15, 2011
Bath salts? Really?
Twenty four year old former heroin addict who bought a ticket to the critical care unit by shooting up with bath salts. She was fine, however, the 6 week old embryo she was carrying was not. Even though she blamed the nursing staff for killing her baby with all the "drugs" we "made" her take, I feel bad for her. I feel bad for her husband, and the two small children they have together. I truly hope she gets the help she needs.
I had no idea this is something that has apparently become popular with kids. This is a video explaining the risks of bath salts in case you are like me and haven't heard of this "drug" before now.
<iframe width="425" height="349" src="http://www.youtube.com/embed/V5kPXH-lMmE" frameborder="0" allowfullscreen></iframe>
I had no idea this is something that has apparently become popular with kids. This is a video explaining the risks of bath salts in case you are like me and haven't heard of this "drug" before now.
<iframe width="425" height="349" src="http://www.youtube.com/embed/V5kPXH-lMmE" frameborder="0" allowfullscreen></iframe>
August 07, 2011
Waste of a promising future:
Apparently chewing Fentanyl patches is the new craze. He was down for who knows how long before his mother found him unresponsive. The paramedics found the patch still in his mouth. It took 20 minutes for the ED staff to shock him back to "life". Currently on life support with very little brain activity. Seriously, how can anybody ever think this is a good idea?
July 31, 2011
Dealing with grief
Today I spent the day shadowing another nurse on the unit. She was absolutely wonderful about taking the time to explain everything to me, and teach me as much as she could. It was hectic and crazy right from the start. We only had one patient, who had come to the emergency room just a few hours earlier. His only complaint was shortness of breath. Within an hour, he declined so quickly he had to have an endotracheal tube placed and was put on a vent. When we received report, we had learned that he had pneumonia, and a suspected pulmonary embolism that was later ruled out. He was on maximum support on the vent and was receiving 100 percent oxygen. Despite this, his O2 sats were only in the 60's and stayed that way all day. He was septic and despite all of our interventions, he was getting worse. I felt sad for this man while helping to provide his care. I wondered if he could hear us despite the sedation, or how aware he could possibly be of what was happening to him. I wondered if he was uncomfortable. He was not expected to survive.
Many family members came to see him. I watched the nurse as she spoke to the family. I observed the reactions and listened to what all the family members had to say. One thing was said frequently by many, "But he was fine yesterday", "But he just said yesterday how well he felt". The wife, the brother, the sister, the niece, the son in law. They all said the same thing. I saw the shock on their faces. Their pain was so intense, you could feel it along with them. It was in the air around you. It was hard to witness this. I had to look away when the teenage granddaughter sobbed. It was so unexpected to all of the family, and in my opinion, that makes it all the harder to deal with.
I was on that side of hospital bed 15 years ago. My mother had a horrible accident that put her in the intensive care unit for approximately 5 months. She was not expected to survive either. Driving home after my shift, I cried. I cried for that man, I cried for his family, and I cried for my mom. I briefly questioned whether or not I was strong enough to do this. But I know I am. This is why I became a nurse, so I could help others in their time of need. I need to recognise that I'm human, that I have emotions, and that it is ok to feel these things, and cry if I need to. I called my grandma, and told her about my day. She cried a little with me, as we both remembered what my mother went through. She told me she was proud of me, and that my mom is watching over me and that she is proud of me too. I felt better after talking to grandma, it was just what I needed.
The man was transferred to another hospital. I will probably never know if he pulled through.
Many family members came to see him. I watched the nurse as she spoke to the family. I observed the reactions and listened to what all the family members had to say. One thing was said frequently by many, "But he was fine yesterday", "But he just said yesterday how well he felt". The wife, the brother, the sister, the niece, the son in law. They all said the same thing. I saw the shock on their faces. Their pain was so intense, you could feel it along with them. It was in the air around you. It was hard to witness this. I had to look away when the teenage granddaughter sobbed. It was so unexpected to all of the family, and in my opinion, that makes it all the harder to deal with.
I was on that side of hospital bed 15 years ago. My mother had a horrible accident that put her in the intensive care unit for approximately 5 months. She was not expected to survive either. Driving home after my shift, I cried. I cried for that man, I cried for his family, and I cried for my mom. I briefly questioned whether or not I was strong enough to do this. But I know I am. This is why I became a nurse, so I could help others in their time of need. I need to recognise that I'm human, that I have emotions, and that it is ok to feel these things, and cry if I need to. I called my grandma, and told her about my day. She cried a little with me, as we both remembered what my mother went through. She told me she was proud of me, and that my mom is watching over me and that she is proud of me too. I felt better after talking to grandma, it was just what I needed.
The man was transferred to another hospital. I will probably never know if he pulled through.
July 23, 2011
Orientation
So I've begun my general orientation for my new job in the critical care unit. I realize that I have alot to learn. Yes, I've been a nurse for several years, and while I have plenty of trach and vent experience, none of it is in acute care. Home health is a completely different ball game from the hospital and I'm worried about my lack of nursing skills. I've never started an IV. I've never even had to do CPR (though I'm quite proficient at changing plugged trachs and bagging with O2 when necessary). I've had minimal opportunity to work with IV meds during my clinical rotations in nursing school. I've completely forgotten all about how to interpret EKG strips. I barely remember the common treatments for various disease processes that are more common in adults. I can't even remember the indications, action, and side effects of alot of the medications commonly used by older adults because I've been in pediatrics for so long.
Luckily the unit I'm on is going to consider me a "new graduate" even though I have many years of experience under my belt. This means that I will get to work very closely with the nurse educator and a preceptor for a full 6 to 8 months. The drawback is that I'm not fresh out of school like the other new grad that started the same time as me. I'm hoping that I didn't forget as much as I think I did, and that as we review the material, it comes back to me fairly easily.
So far today is my second day working with the nurse educator. I really like her. She seems to love what she does, and she is very honest and direct. Her expectations are clear and seem very reasonable. She wants us to succeed and has told us that she will not set us up for failure. It seems that I will get the support and education I need to become a good critical care nurse. The fact that this hospital gives such a lengthy orientation makes me feel good that I can succeed at this.
Luckily the unit I'm on is going to consider me a "new graduate" even though I have many years of experience under my belt. This means that I will get to work very closely with the nurse educator and a preceptor for a full 6 to 8 months. The drawback is that I'm not fresh out of school like the other new grad that started the same time as me. I'm hoping that I didn't forget as much as I think I did, and that as we review the material, it comes back to me fairly easily.
So far today is my second day working with the nurse educator. I really like her. She seems to love what she does, and she is very honest and direct. Her expectations are clear and seem very reasonable. She wants us to succeed and has told us that she will not set us up for failure. It seems that I will get the support and education I need to become a good critical care nurse. The fact that this hospital gives such a lengthy orientation makes me feel good that I can succeed at this.
July 16, 2011
The Next Chapter
It's been a wonderful experience, but I'm ready to move on to the next chapter. In my 5 years in home care, I've seen alot of things. I've gotten to know alot of wonderful people: grandparents, parents, children, other nurses, and the staffing coordinators worked diligently to ensure that families didn't go without a nurse for the day/night. I've also seen a lot of not so nice things: dilapidated and dirty homes, homes with rats, mice, cockroaches, and a myriad of other unwelcome critters, neglected children and their stoned parents, shootings outside the child's bedroom, drug deals, unwanted sexual advances from fathers.....the list goes on much longer than I have time to type. But those things came with the territory. Children with medical needs come from all walks of life, but they all have one thing in common: They all depend on someone to provide them with the love and care that they need.
I gave my employer over a month's notice. Telling all my clients that I was leaving was the hardest thing I had to do. Most were upset I was leaving. There were a few families that I didn't think would mind so much but surprised me the most by their level of disappointment and fear that I was no longer going to be their clinical manager. I reassured everybody the best that I could and hugged everyone one last time. I will miss them all.
The job interview went well. Very well. I interviewed them as much as they did me. I toured the unit. Spoke with a few nurses that worked there. Overall, I had such a positive vibe when I left the hospital. It was less than a week later that I got the phone call and official offer of employment. It's a small critical care unit in a small town hospital. I will be driving about an hour every day to get to work, but it will be worth it. Even though I'm not a new nurse, I'm new to acute care and they will be giving me 6-8 months of orientation before I'm expected to function without my preceptor.
I'm ready and looking forward to my new career as a critical care nurse!
I gave my employer over a month's notice. Telling all my clients that I was leaving was the hardest thing I had to do. Most were upset I was leaving. There were a few families that I didn't think would mind so much but surprised me the most by their level of disappointment and fear that I was no longer going to be their clinical manager. I reassured everybody the best that I could and hugged everyone one last time. I will miss them all.
The job interview went well. Very well. I interviewed them as much as they did me. I toured the unit. Spoke with a few nurses that worked there. Overall, I had such a positive vibe when I left the hospital. It was less than a week later that I got the phone call and official offer of employment. It's a small critical care unit in a small town hospital. I will be driving about an hour every day to get to work, but it will be worth it. Even though I'm not a new nurse, I'm new to acute care and they will be giving me 6-8 months of orientation before I'm expected to function without my preceptor.
I'm ready and looking forward to my new career as a critical care nurse!
June 09, 2011
Erin
I was fond of all of my clients. But there were a few that really tugged at my heart strings, even more than the rest. Erin was one of those. She was a beautiful baby girl that I had cared for since she was 2 months old. I remember very clearly the day I met her. It was just before she was discharged from the hospital. I went to visit her so I could meet her mom and dad, and learn some of her care. Mom was holding Erin, and she was smiling at her mother. I didn’t know this at the time, but that would not only be the first, but also the last time I’d ever see Erin smile.
Her condition quickly got worse after she came home. She was trached, and on the vent 24 hours per day. They did all kinds of genetic testing, but were never able to figure out what was wrong with her. All we knew was that it was a metabolic disorder.
She developed seizures, went into heart failure and got to the point that she no longer responded to anyone. She couldn’t track you with her eyes, she never looked at anyone. It appeared as though she were looking through you, not at you. She didn’t laugh or smile. She only cried or lay in her crib with a blank look on her face. She started having these sympathetic responses that were very sudden. Her little heart would race well over 200 beats per minute, I was scared she’d have a heart attack, and her oxygen sats would drop to less than 50-60 percent in less than 10 seconds. She would turn blue and we’d have to bag her with 100% oxygen while trying to calm her. It was scary. I loved that little girl like she was my own.
Now keep in mind, I am a firm believer in not treating special needs kids any differently than other children. Even though they have a nurse at their disposal all night long, other kids do not, and are expected to sleep through the night (once they are old enough to do so). So I really try not to intervene unless medically necessary. I provide the care they need, keep them comfortable, but try to let them be otherwise. I care for them, show them love, but I certainly do not coddle them. To treat these kids differently from other kids really does a huge disservice to the kids and their parents.
But Erin was different. She was never going to recover and I knew she would not survive. She was getting worse every day. So for months I just held and rocked her all night long and gave her as much love as I possibly could. She never responded to me and I often wondered if she knew she was loved and knew that we were all there for her.
Eventually the parents made the decision to make her a DNR and made the agonizing decision to remove her from the vent. They decided to wait until just after her birthday so that she would at least live to see her first birthday. Erin kept getting worse and fell into a coma. We didn’t think she’d make it much longer. It was heart-breaking, but unlike with Gary, I was determined to stay and help that family. I was NOT bailing.
I had the night off and I was at home relaxing with my family. I got a phone call from the regular day shift nurse. Erin had just passed away. We knew it was going to happen but I was still stunned. I cried and cried with the other nurse on the phone. She was only a week away from her first birthday.
I was still crying, but got it under control as best as I could as I drove to their house. I was very unsure of myself, if I should really go to see them, and wasn’t sure if the family would want me there or not. I was scared of imposing on them since I technically wasn’t working, and I certainly wasn't family But I couldn’t stay away. I cared for the family just as much as I did for their daughter.
When I got there, the family embraced me, hugged and kissed me, and thanked me for coming. I had made the right decision. We were all crying and it was so so sad. The physician was just leaving when I got there, he had pronounced her, and she was already removed from the vent. It was so eerily quiet without the sound of all the equipment running. All you heard were people crying and hushed voices. The family had decided to wait to call the funeral home so that they could have those last moments with their daughter before they came to take her to the funeral home.
At one point I sat down in the rocking chair where I had spent so much time rocking her each night. Mom brought Erin to me and placed her in my arms. I got to hold, kiss, and rock her one last time. I know this sounds so sad, and maybe even morbid to people who don’t understand, but I will forever cherish that memory. That family gave me their daughter during their precious last moments with her, so that I may hold her and say my good-bye’s. I will always be grateful to them for allowing me to have those final moments and for allowing me to be part of their lives.
In a way it was a blessing that she passed on when she did. It spared the family from having to face removing her from the vent and letting her go. This awful decision was taken out of their hands. I'm glad they won't ever have to live with the grief or possible self doubt over the decision to take her off the vent. This family endured something so tragic and fiercely loved a child they will never see grow up. I can't even begin to imagine what that is like. I'm just glad I could be there, and help in whatever small way I could.
Before I finally left for the night, Erin's mother gave me my Christmas present since I wouldn’t be back. It was a beautiful ornament with Erin’s picture in it. I hang it on my tree every year.
Her condition quickly got worse after she came home. She was trached, and on the vent 24 hours per day. They did all kinds of genetic testing, but were never able to figure out what was wrong with her. All we knew was that it was a metabolic disorder.
She developed seizures, went into heart failure and got to the point that she no longer responded to anyone. She couldn’t track you with her eyes, she never looked at anyone. It appeared as though she were looking through you, not at you. She didn’t laugh or smile. She only cried or lay in her crib with a blank look on her face. She started having these sympathetic responses that were very sudden. Her little heart would race well over 200 beats per minute, I was scared she’d have a heart attack, and her oxygen sats would drop to less than 50-60 percent in less than 10 seconds. She would turn blue and we’d have to bag her with 100% oxygen while trying to calm her. It was scary. I loved that little girl like she was my own.
Now keep in mind, I am a firm believer in not treating special needs kids any differently than other children. Even though they have a nurse at their disposal all night long, other kids do not, and are expected to sleep through the night (once they are old enough to do so). So I really try not to intervene unless medically necessary. I provide the care they need, keep them comfortable, but try to let them be otherwise. I care for them, show them love, but I certainly do not coddle them. To treat these kids differently from other kids really does a huge disservice to the kids and their parents.
But Erin was different. She was never going to recover and I knew she would not survive. She was getting worse every day. So for months I just held and rocked her all night long and gave her as much love as I possibly could. She never responded to me and I often wondered if she knew she was loved and knew that we were all there for her.
Eventually the parents made the decision to make her a DNR and made the agonizing decision to remove her from the vent. They decided to wait until just after her birthday so that she would at least live to see her first birthday. Erin kept getting worse and fell into a coma. We didn’t think she’d make it much longer. It was heart-breaking, but unlike with Gary, I was determined to stay and help that family. I was NOT bailing.
I had the night off and I was at home relaxing with my family. I got a phone call from the regular day shift nurse. Erin had just passed away. We knew it was going to happen but I was still stunned. I cried and cried with the other nurse on the phone. She was only a week away from her first birthday.
I was still crying, but got it under control as best as I could as I drove to their house. I was very unsure of myself, if I should really go to see them, and wasn’t sure if the family would want me there or not. I was scared of imposing on them since I technically wasn’t working, and I certainly wasn't family But I couldn’t stay away. I cared for the family just as much as I did for their daughter.
When I got there, the family embraced me, hugged and kissed me, and thanked me for coming. I had made the right decision. We were all crying and it was so so sad. The physician was just leaving when I got there, he had pronounced her, and she was already removed from the vent. It was so eerily quiet without the sound of all the equipment running. All you heard were people crying and hushed voices. The family had decided to wait to call the funeral home so that they could have those last moments with their daughter before they came to take her to the funeral home.
At one point I sat down in the rocking chair where I had spent so much time rocking her each night. Mom brought Erin to me and placed her in my arms. I got to hold, kiss, and rock her one last time. I know this sounds so sad, and maybe even morbid to people who don’t understand, but I will forever cherish that memory. That family gave me their daughter during their precious last moments with her, so that I may hold her and say my good-bye’s. I will always be grateful to them for allowing me to have those final moments and for allowing me to be part of their lives.
In a way it was a blessing that she passed on when she did. It spared the family from having to face removing her from the vent and letting her go. This awful decision was taken out of their hands. I'm glad they won't ever have to live with the grief or possible self doubt over the decision to take her off the vent. This family endured something so tragic and fiercely loved a child they will never see grow up. I can't even begin to imagine what that is like. I'm just glad I could be there, and help in whatever small way I could.
Before I finally left for the night, Erin's mother gave me my Christmas present since I wouldn’t be back. It was a beautiful ornament with Erin’s picture in it. I hang it on my tree every year.
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