As if I need a reason, I'm leaving town. I'm going so far away from the MICU that rectal tubes and being kicked at and poo-covered will be distant memories.
But don't worry! You won't miss me too much, I'll be right over here for a little while :)
Tuesday, October 16, 2007
Seriously.
Seriously. Are you tired of my whining, I-hate-my-job, my-job-is-sucking-the-life-from-my-weary-bones posts? Because, seriously. Last. Night. Sucked.
I don't even know where to start, except to make sure emphasize the fact that I am sick and tired of trying to take care of ETOH-w/d GIB with ESLD, encephalopathy, confusion, and of course nutso. And because that alone is not fun enough, the doctors like the write orders for me to give them either lactulose or Golytely because nothing makes a nurse happy like cleaning up liters and liters of liquid poo. So yeah, that was my night, times two, since I had two patients, in the same situation.
To save you time, I'll sum up the highlights:
- Wondering why his oxygen levels dropped a bit on the monitors, I checked in on Loony #1, only to find him and his bed covered in feces. Patient had a feces-covered washcloth in his mouth, shoved into his mouth, and refused to part with it when I tried to take it out. A brief struggle ensued. Not pretty. And also, my internal nursey filter for How to Speak Therapeutically and with Empathy to Patients at all Times has officially gone south. I now find myself saying things like, "You cannot have poop in your mouth! Open up!" I believe I also heard myself utter, "Seriously. Because it's just gross."
- Wondering why Loony # 2 was not mumbling for a few moments, I checked in to find him attempted to pull out his IV lines and any other tube he could find. When I tried to thwart his efforts, he grabbed at the IV line and pulled the entire IV pump and pole into his bed. Then, since I'm such a party-crasher, he got really pissed off and tried to push me away and wave his arms and hit me.
- When I called out for help to restrain Loony #2, the other nurses ran into Loony #1's room, assuming that's where I was. I'm all, "No, I'm in the OTHER crazy room!"
- During restraint process, involving 5 RNS and a boatload of Ativan, Loony #2 creatively called us all every obscenity he could find. It turns out he's quite an angry misogynist, as he declared that we were all dykes. Big nasty dykes. My neuro assessment was further complicated by his answers to my questions..."Do you know where you are, Mr. Loony?"
"Yeah, I'm at Dyke Central!"
"Do you know what day it is, Mr. Loony?"
"Yeah, it's the Day of Dykes on Trikes!"
There is no checkbox for those responses on the CIWA protocol (alcohol withdrawal) flowsheet, however.
- Loony #1 exercised his lungs for at least two hours by constantly yelling, "Help me!" then claiming that he would be telling his lawyer all about this.
- Later on, Loony #2 earned himself ankle restraints after I dodged several feet and leg kicks aimed at my head. And that internal nursey filter? It didn't stop me from telling him, "Seriously. Just stop talking. Stop talking now." But I could honestly think of no empathetic, therapeutic way to get him to stop spewing every nasty word for women's private parts along with a description of them.
So seriously. At least I feel completely justified when I say, "I need a vacation."
I don't even know where to start, except to make sure emphasize the fact that I am sick and tired of trying to take care of ETOH-w/d GIB with ESLD, encephalopathy, confusion, and of course nutso. And because that alone is not fun enough, the doctors like the write orders for me to give them either lactulose or Golytely because nothing makes a nurse happy like cleaning up liters and liters of liquid poo. So yeah, that was my night, times two, since I had two patients, in the same situation.
To save you time, I'll sum up the highlights:
- Wondering why his oxygen levels dropped a bit on the monitors, I checked in on Loony #1, only to find him and his bed covered in feces. Patient had a feces-covered washcloth in his mouth, shoved into his mouth, and refused to part with it when I tried to take it out. A brief struggle ensued. Not pretty. And also, my internal nursey filter for How to Speak Therapeutically and with Empathy to Patients at all Times has officially gone south. I now find myself saying things like, "You cannot have poop in your mouth! Open up!" I believe I also heard myself utter, "Seriously. Because it's just gross."
- Wondering why Loony # 2 was not mumbling for a few moments, I checked in to find him attempted to pull out his IV lines and any other tube he could find. When I tried to thwart his efforts, he grabbed at the IV line and pulled the entire IV pump and pole into his bed. Then, since I'm such a party-crasher, he got really pissed off and tried to push me away and wave his arms and hit me.
- When I called out for help to restrain Loony #2, the other nurses ran into Loony #1's room, assuming that's where I was. I'm all, "No, I'm in the OTHER crazy room!"
- During restraint process, involving 5 RNS and a boatload of Ativan, Loony #2 creatively called us all every obscenity he could find. It turns out he's quite an angry misogynist, as he declared that we were all dykes. Big nasty dykes. My neuro assessment was further complicated by his answers to my questions..."Do you know where you are, Mr. Loony?"
"Yeah, I'm at Dyke Central!"
"Do you know what day it is, Mr. Loony?"
"Yeah, it's the Day of Dykes on Trikes!"
There is no checkbox for those responses on the CIWA protocol (alcohol withdrawal) flowsheet, however.
- Loony #1 exercised his lungs for at least two hours by constantly yelling, "Help me!" then claiming that he would be telling his lawyer all about this.
- Later on, Loony #2 earned himself ankle restraints after I dodged several feet and leg kicks aimed at my head. And that internal nursey filter? It didn't stop me from telling him, "Seriously. Just stop talking. Stop talking now." But I could honestly think of no empathetic, therapeutic way to get him to stop spewing every nasty word for women's private parts along with a description of them.
So seriously. At least I feel completely justified when I say, "I need a vacation."
Sunday, October 14, 2007
Word.
With apologies to Head Nurse, what she says explains a lot...
Nurses believe in God, I think, primarily to have somebody to blame. All I can say is, when God and I meet up at the end of my life, we are gonna have one Hell of a Come-to-Jesus meeting.
Nurses believe in God, I think, primarily to have somebody to blame. All I can say is, when God and I meet up at the end of my life, we are gonna have one Hell of a Come-to-Jesus meeting.
Things that are funny...
There are certain things that seem hilarious at four in the morning, that sort of lose something during the "real day" when normal people are awake and the sun is shining.
Last night at work the palm of my hand kept stinging every time I put alcohol gel on it. I noticed I had a tiny divet in my palm, the shape of a fingernail, I must have been clenching my fists while sleeping again. So the following conversation took place:
Me: This little cut on my hand is killing me! Stupid alcohol gel...
RN Friend: Weird. What's it from?
Me: (examining hand closer) Not sure...strange place for a cut...must be stigmata.
RN Friend: Cool. You should use that as an excuse to call in sick.
Me: Ooh! Good idea! 'Hi, Charge Nurse? Yeah, this is Rosebuttons RN. I'm calling in sick for my night shift tonight, maybe the next few nights too...yeah, I've got the stigmata.'
RN Friend: Perfect. They can't argue with that, you know you can't come to work if you can't control your secretions.
Me: Total infection risk.
RN Friend: I gotta get some of that stigmata.
So on my handy List of Excuses for Calling in Sick, I shall add Stigmata right after Scurvy and right before Pink Eye.
Again, apologies for insulting any more religious groups, as I probably did in my previous post as well. But what good is an organized religion if they can't laugh at themselves too?
Last night at work the palm of my hand kept stinging every time I put alcohol gel on it. I noticed I had a tiny divet in my palm, the shape of a fingernail, I must have been clenching my fists while sleeping again. So the following conversation took place:
Me: This little cut on my hand is killing me! Stupid alcohol gel...
RN Friend: Weird. What's it from?
Me: (examining hand closer) Not sure...strange place for a cut...must be stigmata.
RN Friend: Cool. You should use that as an excuse to call in sick.
Me: Ooh! Good idea! 'Hi, Charge Nurse? Yeah, this is Rosebuttons RN. I'm calling in sick for my night shift tonight, maybe the next few nights too...yeah, I've got the stigmata.'
RN Friend: Perfect. They can't argue with that, you know you can't come to work if you can't control your secretions.
Me: Total infection risk.
RN Friend: I gotta get some of that stigmata.
So on my handy List of Excuses for Calling in Sick, I shall add Stigmata right after Scurvy and right before Pink Eye.
Again, apologies for insulting any more religious groups, as I probably did in my previous post as well. But what good is an organized religion if they can't laugh at themselves too?
Tuesday, October 09, 2007
Bloodless
Last night I took care of a patient who had recently undergone chemotherapy and radiation, and was admitted to the MICU with severe anemia. Specifically, his hematocrit on admission was 14. Then the next day it was 13, then 12, then 11. That's what we call Super Low (or critical, whatever) since the average male should have a hct of at least 45% and we would nearly always transfuse for hct of less than 25%. But this particular patient, due to his personal religious beliefs, refused any transfusion of any type of blood products. He was not confused, and quite oriented, and understood that he could die without a blood transfusion. His cancer is still treatable, but he could not have any more chemo or radiation until his blood counts were back into a safe range. I think I am usually very nonjudgemental of my patients lifestyles, religions, or personal beliefs, but I am having a lot of trouble with this one.
His wife stayed overnight in the room with him, despite it being against our unit policy. But other nurses had previously allowed her to, and once the precedent has been set I hate being the bitch who suddenly enforces the rules. So I agreed to it, but with the warning that if her presence interfered at all with nursing care, I would have to ask her to leave. She put his side rail down and pushed the chair-bed right next to his bed, but I constantly had to wake her up and push the chair aside in order to be able to access my patient. Since he had just received four liters of Golytely and required very frequent cleaning up, I needed to make her move quite a lot. Freakin' Golytely. At one point, upon seeing the entire bed transformed into a lake of dark brown foul-smelling liquid, she sighed and said, "Wow. Awww. Wow. I'm just so surprised, he's only had one little Ensure shake in the past few days." Umm...four liters of Golytely go in, four liters of Golytely must come back out. And then some. I wondered if dayshift had silently administered the Golytely into his feeding tube without explaining the outcome? And she hovered around while I cleaned him, at one point even patting me soothingly on the shoulder and saying, "Aww. Wow, you poor thing. Wow." I bristled. Good thing the lights were dim in the room, or she may have noticed me narrow my eyes and the little hairs on the back on my neck stand up. I'm a nurse, a highly trained and well-educated ICU nurse, this is my job, this is what I do, I'm being paid for it and I chose to be here. Don't pat me on the shoulder.
The patient was pale as a ghost, lethargic and very weak. I didn't draw labs on him since the docs didn't order any, and they want to minimize blood draws as much as possible, for obvious reasons, so I don't know what his hct was this morning. The charge nurse and I discussed possible transfer out of ICU to the medical floor...after all, what could we do for him? Yes, he was full code status, but we could not transfuse. We cannot treat his life-threatening anemia, except with epo shots and iron supplements. He is not a surgical candidate. He is not intubated and his other vital signs and pressures are stable. So it sort of makes sense, he doesn't need to be in the ICU. But it struck me that his status would be downgraded, to a different level of care, essentially because of his religious beliefs. Is that weird?
I'm still thinking about this one. I'm still having trouble with it, because it doesn't make sense to me and I have trouble accepting it. Sure, a lot of religious convictions and beliefs don't make sense to me, but usually I can accept the differences in belief and move on from there. But this just doesn't sit well with me. I can't wrap my little secular head around it. Why does that one specific thing in the bible, regarding blood, get translated and adhered to so literally? Why do they accept all of our other medical advice and interventions without investigation or comparison to scripture?
And I'm confused by myself...I left the same t-shirt (his garments?) on a Mormon patient in the ICU for days and days and worked around it, I carefully wrapped and re-wrapped a head scarf around a young Muslim woman each time before a male physician entered her room, I timed certain medications around prayer times so a Muslim patient could pray, I made fifteen-minute checks on a my Hasidic Jewish patient because after sundown on a Friday she could not use the call light, I've bent the unit policy and allowed more than the requisite number of visitors into a patient's room so they can pray together, and not one bit of any of these actions bothered me. Rather, I consider it to be a crucial part of a nurse's job, since I am caring for the whole patient. But at the same time, I guess none of those things ever compromised a patient's care or well-being, either.
So anyway. This is just a big old can of worms I might be opening. Perhaps this is a controversial topic, maybe I seem callous or judgmental. I sort of feel that way. But I just don't get it.
His wife stayed overnight in the room with him, despite it being against our unit policy. But other nurses had previously allowed her to, and once the precedent has been set I hate being the bitch who suddenly enforces the rules. So I agreed to it, but with the warning that if her presence interfered at all with nursing care, I would have to ask her to leave. She put his side rail down and pushed the chair-bed right next to his bed, but I constantly had to wake her up and push the chair aside in order to be able to access my patient. Since he had just received four liters of Golytely and required very frequent cleaning up, I needed to make her move quite a lot. Freakin' Golytely. At one point, upon seeing the entire bed transformed into a lake of dark brown foul-smelling liquid, she sighed and said, "Wow. Awww. Wow. I'm just so surprised, he's only had one little Ensure shake in the past few days." Umm...four liters of Golytely go in, four liters of Golytely must come back out. And then some. I wondered if dayshift had silently administered the Golytely into his feeding tube without explaining the outcome? And she hovered around while I cleaned him, at one point even patting me soothingly on the shoulder and saying, "Aww. Wow, you poor thing. Wow." I bristled. Good thing the lights were dim in the room, or she may have noticed me narrow my eyes and the little hairs on the back on my neck stand up. I'm a nurse, a highly trained and well-educated ICU nurse, this is my job, this is what I do, I'm being paid for it and I chose to be here. Don't pat me on the shoulder.
The patient was pale as a ghost, lethargic and very weak. I didn't draw labs on him since the docs didn't order any, and they want to minimize blood draws as much as possible, for obvious reasons, so I don't know what his hct was this morning. The charge nurse and I discussed possible transfer out of ICU to the medical floor...after all, what could we do for him? Yes, he was full code status, but we could not transfuse. We cannot treat his life-threatening anemia, except with epo shots and iron supplements. He is not a surgical candidate. He is not intubated and his other vital signs and pressures are stable. So it sort of makes sense, he doesn't need to be in the ICU. But it struck me that his status would be downgraded, to a different level of care, essentially because of his religious beliefs. Is that weird?
I'm still thinking about this one. I'm still having trouble with it, because it doesn't make sense to me and I have trouble accepting it. Sure, a lot of religious convictions and beliefs don't make sense to me, but usually I can accept the differences in belief and move on from there. But this just doesn't sit well with me. I can't wrap my little secular head around it. Why does that one specific thing in the bible, regarding blood, get translated and adhered to so literally? Why do they accept all of our other medical advice and interventions without investigation or comparison to scripture?
And I'm confused by myself...I left the same t-shirt (his garments?) on a Mormon patient in the ICU for days and days and worked around it, I carefully wrapped and re-wrapped a head scarf around a young Muslim woman each time before a male physician entered her room, I timed certain medications around prayer times so a Muslim patient could pray, I made fifteen-minute checks on a my Hasidic Jewish patient because after sundown on a Friday she could not use the call light, I've bent the unit policy and allowed more than the requisite number of visitors into a patient's room so they can pray together, and not one bit of any of these actions bothered me. Rather, I consider it to be a crucial part of a nurse's job, since I am caring for the whole patient. But at the same time, I guess none of those things ever compromised a patient's care or well-being, either.
So anyway. This is just a big old can of worms I might be opening. Perhaps this is a controversial topic, maybe I seem callous or judgmental. I sort of feel that way. But I just don't get it.
Friday, October 05, 2007
Overheard at work...
Chipper Dayshift Charge Nurse: Good morning, Susie!* How was your vacation?
Dayshift Nurse: It was wonderful, I had a great time. Until I had to come back to this hellhole.
Chipper Dayshift Charge Nurse: (nervous giggle) Oh, haha, it isn't that bad, now is it?
Dayshift Nurse: (without a trace of irony) Yes, it is.
I promise, the above conversation was overheard at work, and I also promise, it wasn't me. Not yet anyway. I suspect that I will actually have to return from my Grand Adventures, however. So stay tuned.
To anyone out there who is not a nurse, or a travel nurse, or in a job or field where it may be difficult to find jobs, and if you hate your job, and every cell of your body cringes at the thought of starting yet another 12 (or 8) hour shift, I heartily sympathize with you. Because just this morning I realized that if I didn't have just a few weeks left at this hospital assignment, and if I didn't have a bazillion other nursing job options to pick and choose from, I would be even more morose and depressed and whingey than I already am. And that's saying a lot.
I've had four days off of work, and it felt absolutely sinful and delicious. I slept late every morning (I love you, Mr. Melatonin and your little buddy Benji Benadryl), I cleaned my house (even the bathroom floors!), I cleaned out my closet (must make room for Paris shopping!), went to the grocery store, and dropped off the clothes at Goodwill. I also made it to the pharmacy because unhappy stressed ICU nurses must NEVER run out of migraine medicine.
And oh! The best part. HBO and Showtime On Demand. My thoughts so far? The Tudors: Showtime should probably have left the period piece to BBC or A & E. But I will continue to watch it. Because it's Jonathan Rhys Meyers. I'm obsessed with all things Tudor-history, as geeky as that may be. Weeds: Love it, but maybe a bit too much cops/gangsta drama this season. Californication: So far, funny funny. And pretty well-written. And David Duchovny? Yes. Just...yes. I have loved him ever since the days when I would have given my right pinky finger just to be the Agent Scully to his Mulder, and he rocks in this show, as a drunk and drugged-out bitter divorced misplaced New York writer bitching about living in LA.
So that's what I've been up to lately. Sorry, not much nursing content in this post. Mostly because I've had a few days off, but also because I hate my job. Which makes me sad, because I used to love being a nurse, and I've even had jobs where I would truly look forward to starting a shift. I want to love nursing again. I miss you, nurseywork.
Dayshift Nurse: It was wonderful, I had a great time. Until I had to come back to this hellhole.
Chipper Dayshift Charge Nurse: (nervous giggle) Oh, haha, it isn't that bad, now is it?
Dayshift Nurse: (without a trace of irony) Yes, it is.
I promise, the above conversation was overheard at work, and I also promise, it wasn't me. Not yet anyway. I suspect that I will actually have to return from my Grand Adventures, however. So stay tuned.
To anyone out there who is not a nurse, or a travel nurse, or in a job or field where it may be difficult to find jobs, and if you hate your job, and every cell of your body cringes at the thought of starting yet another 12 (or 8) hour shift, I heartily sympathize with you. Because just this morning I realized that if I didn't have just a few weeks left at this hospital assignment, and if I didn't have a bazillion other nursing job options to pick and choose from, I would be even more morose and depressed and whingey than I already am. And that's saying a lot.
I've had four days off of work, and it felt absolutely sinful and delicious. I slept late every morning (I love you, Mr. Melatonin and your little buddy Benji Benadryl), I cleaned my house (even the bathroom floors!), I cleaned out my closet (must make room for Paris shopping!), went to the grocery store, and dropped off the clothes at Goodwill. I also made it to the pharmacy because unhappy stressed ICU nurses must NEVER run out of migraine medicine.
And oh! The best part. HBO and Showtime On Demand. My thoughts so far? The Tudors: Showtime should probably have left the period piece to BBC or A & E. But I will continue to watch it. Because it's Jonathan Rhys Meyers. I'm obsessed with all things Tudor-history, as geeky as that may be. Weeds: Love it, but maybe a bit too much cops/gangsta drama this season. Californication: So far, funny funny. And pretty well-written. And David Duchovny? Yes. Just...yes. I have loved him ever since the days when I would have given my right pinky finger just to be the Agent Scully to his Mulder, and he rocks in this show, as a drunk and drugged-out bitter divorced misplaced New York writer bitching about living in LA.
So that's what I've been up to lately. Sorry, not much nursing content in this post. Mostly because I've had a few days off, but also because I hate my job. Which makes me sad, because I used to love being a nurse, and I've even had jobs where I would truly look forward to starting a shift. I want to love nursing again. I miss you, nurseywork.
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