I'm baaack!

Hey ya'll I'm still here. I just got back from my yoga workshop in Asheville NC. I will write about this wonderful trip I had soon, but now I am exhausted as it took us 20 hours to get home instead of the 4 hours we were promised. Sigh.

Thought for the day for anyone who wishes to pass the time...

If you were a patient, would you want YOU for your nurse???

If these stretchers could talk

It is my observation that you can put people into two catergories, A)Those who love codes and B) Those who hate them. I am in the "A" column...I love a good code.

The first code save I was witness to happened in my senior internship at Dartmouth ED. 47 year old male decided to have his chest pain checked out randomly one day after having intermittent pain x 2 weeks(much to the dismay of his wife, a cardiac nurse). He came in, was placed on the monitor and within seconds his eyes rolled back in his head and we went into Torsades. My preceptor and another nurse promptly shocked him and brought him back to life. It was one of the coolest things I had witnessed in my life. I was in love.

After I became a nurse I became ACLS and PALS certified immediately (not only because of my love for that stuff, working in ICU it was required). Four months after that I became an ACLS instructor. I love it.

So you can imagine my excitement the other day when we had an interesting code. 90 something year old woman who was in the ED with nausea. She was tiny, about 80 lbs soaking wet, with diabetes, a cardiac history, and a bilateral above the knee amuptation, in addition to other medical problems. She was what we all call a train wreck. She developed chest pain, then SOB, then went semi-unresponsive in a matter of minutes. We moved her to a critical care room and hooked her up to the monitor. Not good. We all know that second we look up at the monitor and see those large and ominious tombstones. Not good.

But then, a PVC. And then another. Then a couplet. Bigemeny. Trigemeny. V-tach (with pulse). Shock. Tombstones, pulseless. V-tach, pulse. Shock. And so on and so on. It felt like we were in the megacode testing section of ACLS and someone was trying to trick us. We gave Lidocaine, Atropine, Epi, Retavase. By the end of it she was on Amiodarone and Heparin drips. It was a really good test of our teams skills.

But the whole time it felt like torture to me, and I had a flood of those old feelings from the ICU come back to me. These old, frail, sick people who are dying and we just can't let them go (usually because the family just isn't ready). When in that situation I usually feel very torn, as if I'm in a war and torturing someone for information. It's a very challenging situation for me because I know if it was my mother or father or husband in that situation I wouldn't let go of that hope that they might come back either...But I also know that most of those patients in that situation are ready. And for me, a situation like this is one of the most heart-renching and difficult situations we face at our jobs. When to draw the line between playing God and just letting things be as they are.

So amongst all of these feelings the daughter was there, crying and talking to her mom. Saying "oh mom, oh mom," while we're pushing Retavase. And then, we helped her understand that it was time, and since she didn't want us to intubate or press on her chest, we needed to stop. And we did. And she passed away.

Eventually the daughter left, the funeral home came and got the body, I cleaned the stretcher. Within five minutes there was another patient in that very same bed where another person had just passed away. The next patient was a happy, healthy 60 year old with a TIA. He was laughing, making jokes, and had a lovely wife and daughter at his side.

Not only thirty minutes ago I been struggling with my internal debate over letting someone go or carrying on with the code. How quickly we can shift gears and move on huh? The new family had no idea what had just gone on, the magnitude of what we had all just experienced, and the work day forged on.

This happens every day. Maybe not as dramatic as this but to some degree. We go from CPR to suturing a little girl with a lip lac. We put people in 4 points and then start an IV on a pregnant woman with hyperemesis. We are constantly switching gears, moving on, and to me that is just amazing.

So the new family, the TIA family, commented on how good the room smelled upon their arrival. It was funny because to me, that was the lingering smell of death, to the daughter, it smelled like brownies. If only those stretchers could talk huh?

Awww

I am about to cry.

Lily just paid me $10 (Monopoly money, of course) for "doing a good job, momma."

Makes my heart want to explode with love and joy :)

My story

Everyone has his or her own version of this story...Here's mine.

I was in my senior year of college, on my way to becoming a nurse. It was a Tuesday morning and we were starting our rotation on the Psychiatric Unit at Dartmouth-Hitchcock Medical Center. My only experience with psych patients to this point had been from behind the thick glass of the nurses station in my local ED where I worked as a CNA. I was scared shitless.

We were getting our tour of the unit when someone spotted the World Trade Center on TV. We all instantly recognized it but it did take a second or two to realize that something was wrong...the damn building was smoking. We paused for a minute or two, and continued on with our tour.

About halfway through our day my nursing instructor called us all to a meeting. We sat in a circle and began discussing what was going on in New York City. I can remember trying really hard not to cry but wasn't successful. I was crying for all of those families who didn't know where their loves ones were. I was crying for those poor people who were trapped inside those buildings. I was crying because my mother was flying to Florida the very next day. And I was crying for the firefighters.

At that point Donnie and I had been together only a few months. We fell head over heels in love instantly and had a special connection. I had only known this man a short amount of time and my heart was breaking at the very thought of him being in that situation as were other firefighters. I couldn't stop thinking of the wives, children, parents, and partners of the firefighters whose loved ones were on shift that day. What were they going through? The pain and worry was overwhelming.

We were dismissed early that day. As you can imagine, the images of the Twin Towers collapsing was just a little too much for the patients on the psych ward to handle that day. Why no one shut off the TV on the unit is beyond me...Perhaps it was for the same reason we all didn't shut off the TV, we just couldn't.

I remember getting home that day and finding my roommates on the couch (I lived with three other girls). They didn't move from that spot for hours. I, on the other hand, didn't even pause my day. I picked up my books and a snack and headed off to the library to study. After that, I worked on a care plan. I went through the motions of my daily life like that for 3 days. Only for a few minutes did I actually sit down and watch the footage, and that was only to be social with the girls.

Friday morning I packed up my car and headed home. One of Donnie's best friends was getting married that weekend and I told him I'd be his date. Right outside of Concord, NH there was a song on the radio. It was a Bruce Springstein song with voice overs from the tragedy. People were crying, screaming, commenting on what had happened. It was a beautiful piece of work. It was also the one thing that broke my shell. It finally hit me what had happened at that moment and I couldn't handle it. The flood gates opened and I started to cry. And cry and cry and cry. So much that I had to pull over to the side of the road.

I had gone through the motions of being sad but before that moment I hadn't really meant it. I think it was all too much for me to handle so I just kept busy to avoid dealing with my real feelings about the whole situation. Yes, I did cry and yes I was sad but it didn't affect me until that moment. Then I let me guard down and truly felt what had happened.

I learned a very important lesson that week. I am so good at keeping busy that sometimes I don't ever take the time to stop. I don't think this is a problem that only I face, I think it's sort of the norm in the American culture. I know it's something that I have to work on and I am trying.

So now, here I sit, five years later. Married, 3 kids, 2 jobs, and a different person than I was when those towers were hit. It's amazing what can happen in 5 short years, and it's even more amazing how quickly five years can pass. I can't even begin to think what the next five have in store for us...

:(

Sad this morning.

Pat (my bro in Baghdad) called me yesterday and I missed his call. Sad.

9/11 today. Too sad for words.

So tired.

Must
sleep but can't
tear myself away
from the Internet.

Deep breath and PUFF

I've been thinking about how much of a pain in the ass (hee hee, literally) it is to give our cocktail. You know which one I'm talking about right? The three shots in the bum of Haldol/Ativan/Benadryl we use to chemically sedate patients who are out of control. You've got to draw them up, label them somehow so you can document what went where in the body, don gloves and THEN step into a room with a person who is usually psychotic and pissed off and shoot them up when they're at their angriest. It's like sticking a banana up the nose of a bull during a bullfight...it just aint right.

So here are my proposed new methods of infusing Ativan (or insert your favorite med here) into the world without actually having contact with the patient.

1. Ativan blow darts. Man o man would we have fun with this one. Anytime a patient is getting rowdy just suck in some air and puff in the general direction and WHAM, they'll go down like one of those elephants who has escaped from the circus (Note to self, must spend hours of practice on aim on my children during the "witching hour").

2. Ativan rectal gel. We do it was valium, why not Ativan? Just grease up the inside of the patients johnny pants and wait them out. In my experience psych patients really like to talk and talk and talk, so just let them do their thing while the jelly works its way up. This could also be a handy payback joke to the local paramedics. Just a little on the ambulance seat and you're golden.

3. Ativan cool mist. I envision a switch behind the desk where you can simply turn it on and watch the calmness wash over the patient. This can also double as the "Cool Your Jets" Room for fellow nurses, physicians, PAs, and NPs who are just having a really tough day. Or any family member who needs to simmer down. Or anyone from administration. Or, well, I'll stop there because I think this one could go on and on. Why not just put an Ativan mist in every room in the hospital? I'm SURE that would increase our satisfaction scores.

4. Ativan laced Turkey sandwiches. Because everyone who is in our department wants breakfast/lunch/dinner this would be a very easy way to sneak in some sedatives. Note to self, LABEL laced and non-laced varieties or nursing staff will be incompacitated.

Those are my top 4 choices. If you think of more, please don't hesitate to write me and share. Some day, our fantasy may become a reality. Though, we'd really have to come up with some pretty strict policies on when you can use these, because I have a sneaking suspicion that if we had Ativan blow darts it would be way too much fun to resist using at least a few times a shift :)

Wa-hoo!

Hey everyone, it'schange of Shift!

Sharpie

I can't even start to tell you guys how happy that I am home and not at work anymore. I just left there and it was sooo asshole and psych night. Everyone we took care of was either wanting to kill himself or a complete a-hole. Annnd, you know it's going to be bad when the cops call and tell you to have the "shots" ready because they're bringing in a "live one."

But, we did have a good crew on so it was OK. Plus, we ordered out and I got this amazing white pizza so that made me pretty happy.

Oh yeah, guess what? My insomnia is totally back. I can go years without it flaring and then all of the sudden it pops back in my life like an old boyfriend looking for a booty call. So now I'm making myself stay up late so maybe I will be able to actually get tired tonight. No matter what happens I'm going to be up around 6 with Sam so I guess it's a crap chute anyway you look at it.

On the bright side, my two friends and I all took over 2 1/2 hour naps this afternoon (so at least insomnia helps me nap :). I put them in their beds at noon, laid on mine and the next thing I knew my clock said 2:17 (I have to be at work at 2:45). So I got dressed (and, oops, I had fallen asleep with wet hair, so did something with that mess), woke the kids, and was out of the house at 2:31...not too bad huh? It was really funny though, I went to wake Lily up and she wasn't in her bed. So guess where I found her? In her closet! She had taken her nap on a blanket on the floor of her closet. Poor kid's going to have f'ed up sleeping habits like I do. Sigh.

PS- Are you supposed to laugh when your 2 year old writes on your new stairs with a sharpie? Yeah, my husband didn't like that either. I've got so much to learn. Double sigh.

So sad

R.I.P. Crocodile Hunter. The world was a better, and more interesting, place with you in it.

Make-up

I's sorry to be one of those moms who is constantly telling stories of her kids, but I can't help it! So here's one more.

Lily was putting on make-up the other day before I took her to the gym's child watch. As we were walking down the stairs she said to me, "Momma, I'm pretty with make-up." Then she stopped short, looked up at me and I swear I saw a light click on above her head, and she said "Boys going to be there?"

Seriously!!!! She's 2 and already asking about boys. I'm bidding on a chasity belt on ebay as we speak.

GD Sudafed

Now I have that stinking cold that everyone else has. I am NOT a good sicky because all I do is whine. It's not even a bad cold, just annoying. Everytime I leaned over to start an IV my nose fountain would oven up and I'd be caught in that embarrassing dilemma...Let it drip or wipe it on my clean gloves.

So when I was sitting at the desk trying to pull off that snot-suck-up-the-nose maneuver the ED Doc said "You're not pregnant are you?" I replied with a quick, and very professional, "Fuck no" (in a quiet voice so no patients could hear, of course) she ran to her bag and brought me Sudafed. Now, let me tell you a little about me and Sudafed...it makes me a hyper crazy wired person. And for you out there that know my baseline, hyper/crazy/wired is a scary scary scary thought. For those who don't know me, I have a considerable amount of energy at any given time, and at my best am usually a bit wired and crazy.

Anyway, so now I'm at home with a perfectly clear nose and I am WiREd!!! I've already been laying in bed for an hour tossing and turning and cursing that G.D. Sudafed. So now, I've taken an Ativan and I'm patiently awaiting it to kick in. Once I'm done writing this I'm going to do some yoga and hopefully that will do the trick. If not, I'm off to clean my windows and vacuum. If I can't sleep everyone should be up, right :)