28 days

This is an actual conversation I had with my husband the other day.

Donnie:
"We were watching TLC the other day at work, some show about female things, did you know that women don't have their periods for 6 days, it's actually 28 days long."

Me: (And those of you who know me, this is said in my dead serious but sarcastic voice coupled with a straight face. Yes, the same one I use on patients every day I'm at work)
"Wow, really?"

Donnie:
"Yeah, the whole cycle actually lasts for 28 days. I guess that's why most women are so f-----d all of the time, because every day of the month they're having some sort of hormone changes."

Me: (Same face)
Dead silence.

Me:
More silence (cue crickets chirping in the background)

Me still today:
Shocked and silent.

Really, what do you say to that? How is it that a well educated man, who's 35 with THREE children didn't know that? I blame the public school system.

Things that make you go hmmmm

Here's one thing that blows my mind about the ED. How do people know why kind of special of the day we're having? There is no sign outside, no menu, no airplane flying overhead with a banner attached...so how do the patients know that they're supposed to complain of the ailment that day?

Last Saturday it was finger lacerations. Sunday was a migrane day. Tuesday we had a pedi clinic. Last night it was abdominal pain.

But not only abdominal pain, it was three very similar cases. All in their 80s, with dementia, female, and doting family members. AND they all came in within two hours of eachother. Actually, now that I'm thinking about it, we got two women- each in her 70s- with end stage COPD on Sunday night within 5 minutes of eachother, both in respiratory failure, sitting side by side in our critical room.

And we all know this is true. It happens more often then we actually think or talk about but I really think it's an interesting phenonomen. There are the obvious reasons for the obvious situations. I'm sure the double respiratory failures had to do with the humidity we've been having lately. There's always more suicidal patients around the holidays, more CHF at Easter, Monday's are always busier after a holiday weekend. Those things you can count on. I'm talking about the odd things, like 6 people slicing their fingers at 6 pm on a Saturday.

What cosmic forces are out there coordinating this stuff? I don't want to even think of broaching the topic of religion vs. spirituality (those who know me know my true and very stong opinons on both) but this is really a funky thing we experience. With all of the things that can go wrong with the human body, why do they all seem to happen at the same time to our patients who have nothing in common?

This, I know for a fact, is bad.

(Disclaimer for all of you non-medical peeps out there, please DO NOT read on if you're grossed out by puss or blood, this is not the entry for you to read OK? If you do read on, you were warned and I don't want to hear any complaints about the contents of this entry. Got it???)

This, I know for a fact, is bad...
I was turned on at work yesterday. For ALL the wrong reasons.

I have always known I wanted to be an ED nurse. Just something I felt in my gut. Yesterday, around 1900 I had actual confirmation that I'm doing the right kind of nursing. Because yesterday I watched my first pilonidal cyst (for you non-medical sort, it's an abscess in your butt crack) be lanced and was so fascinated that I have been thinking of it all day long today.

Don't get me wrong, I'm not a pervert or anything, but I do love to pop and pick things...a lot. I have scars all over my body (including an incision on my knee from surgery) that were wounds which should have healed but never allowed because of my wandering hands and now remain scars. I can't stop myself, if there is something to be picked or popped I'm all over it. Just ask Donnie what a "treasure" is in our house.

Which is why you can understand why I was so excited by this cyst. It was like a soda can exploding after its been shaken too hard, just so breathtakingly gushy and gross. Then the surgeon put pressure on either side of the incision (as if popping a zit) and MORE came out. I let out a moan. It was great.

Is that bad? Or do I just need a lot of therapy? (Retorical question, of course. I really really really don't want to hear the answer to that question).

The Bridge

Today was one of those days that I can identify with that woman who threw her three small children off of the Golden Gate Bridge (Well, except that she was schizophernic, details, details, details...). I worked last night, managed to get to bed by midnight or so, up at 6 (Donnie's at work today). Pretty good night in my book.

BUT, the baby took a really early nap today. And Lily took NO NAP at all today. Which, as you other moms know, makes for a very loooong and trying afternoon. We had a playdate this afternoon and Lily was really bad; kicking her brother and hitting the other kids (which is mortifying because then I worry that I am a horrible mommy and can't control my 2 year old). I think she had about 45 timeouts total. By bedtime I was damn near tears because I had just had it.

And I know that I am supposed to enjoy my kids, but days like this I feel like the worst mommy in the world because I just can take so much. I just happen to be one of those lucky moms who has a great support system and people to intervene when I get "the look". People who know me well and know when it's time to hide the car keys so I can't go to the nearest bridge...

But then, after they're asleep all of that anger and frusteration floats away and I wish they were awake to play with. What a horrible Catch-22 huh? They make you nuts, and you can't get enough!

PS- For your viewing pleasure...

This photo is pretty great. This was from yesterday morning after the kiddos had taken thier bath. I was changing Lily's sheets and left the mattress on the floor for "gumping" as she calls it. Sammy loved it even more than she did, however, and crawled up on one side and down the other just laughing himself silly. We played with it for nearly an hour. This photo was taken as Lily was jumping and Sam falling off the other side.

The other photo was after the jumping was over and they were taking a breather. Aren't they cute (And look at her tan!! I swear, we put sun block on her).

A quickie but a goodie

How many perverts does it take to screw in a lightbulb?

Only one, but it takes an ED staff the entire shift to remove it...

Have a great night everybody!

Oh, oops, do I have VRE? Is that bad???

Tonight's one of those nights when I come home and feel as if I need my own decon shower outside of my house. We had a dialysis patient who was in CHF. No big deal right? Well, when I called the hospital we were transferring him to (we don't do dialysis) they said, "Oh yeah, Mr. X, we know him really well. He's VRE+, right." I'm all, "Um, well, um, I don't know, he never mentioned it."

I hate when patients neglect to mention that they have something contagious. We are really good about the obvious things (For example: cough and fever=mask; open gushing wounds=gloves) but not so good at guessing the others. So that's why, when you got something, TELL US!!! It's not that hard and it keeps other patients from getting said contagious thing and keeps us from taking stuff home. Man o man.

Frozen Peas

When I was 17 I tore my ACL in my right knee playing field hockey. Then I tore it again when I was 19 playing lacrosse in college. Then I tore it again working out when I was 20. So now, I'm 25 years old and I've had 4 knee surgeries; two reconstructive and two arthroscopic to fix all of the torn cartilidge that comes along with tearing your ACL. So as you can now imagine, I have arthritis and chronic pain in my right knee from all of this crap that has happened.

So put that all into perspective with this 5 weeks of rain we've had this season in Maine (I am one of those people who can always tell when it's going to rain or snow because of the amount of swelling in my knee), the humidity in the air, compounded with a job in which I am on my feet for the majority of the day-4 days a week, and an active lifestyle where I'm always on the go.

I don't want to complain but I think I need to get it out of my system today. This is not the problem that any 25 year should be dealing with, as my neighbor told me, "That's an old person's problem." People are always asking me how I feel about my knee problems and I just tell them that we all have our ailments, this is just mine. Some people have diabetes, asthma, hypertension, asshole personalities, glaucoma, etc etc etc...this is just what I deal with.

Plus, it's really cute because Lily keeps asking to see my "owie" and this morning told me her knee hurts. So we wrapped it with an ace bandage and she got her own bag of frozen peas on her knee and we iced and elevated together while watching the Wiggles (by the way, has anyone noticed that Greg has gained weight this season, or is that just me???). It was really cute and one of those memories that I will always have...my little friend and I hanging out on the floor with our owies. So maybe I'm hurt for a reason, so I am forced to have down time and relax with my little friends and husband. Not too bad of a gig if you ask me...

My Son Sam

I wanted to share this photo of my little friend Sam sleeping. He looked like this the night I came home from work. It was a bad night where we had to put a 12 year old in 4 point restraints, during which I got three scratches from his dirty fingernails and spat upon. It was horrible, then I got home and saw Sammy sleeping and it all melted away.

The Back Lady

I was shopping the other day and overheard the lady behined the cash register complaining about the ED where I work. Apparently she had come in to the ED twice in the same day, via ambulance, with a cc of back pain--from what I gathered the end result was a muscle strain. The first time they sent her home, she didn't do what they suggested (ice, Ibuprofen, etc) and then returned only to be sent home a second time. Whatever, really, it happens right? People leave unhappy all of the time, part of the job ya know.

But what really bothered me was that she said it was because she didn't have private insurance that we didn't admit her or take her more seriously. When I first started in the ED they told me this was the rationale for triaging a patient prior to registration (well, that and the whole legal issue of letting someone who's really sick sit in the waiting room, that small little detail) but I didn't believe it. I was truly that ignorant to think people actually thought we cared about what sort of insurance they carried. Whoa was I wrong.

It was not appropriate for me to butt in on her conversation, no matter how much I really wanted, and set her straight. I wanted to tell her that we give the same care to everyone, regardless of their race, ethnicity, insurance (or lack thereof), living situation, sexual preference, economical or social status, and attitude towards us. I wanted to tell her that we HAVE to take care of everyone because of the nature of the ED. We can't turn our noses at people, for a majority of them we're their primary health care.

But I said nothing. Maybe that makes me a coward, maybe it was the smart thing to do. I really don't know. One of my co-workers told me her solution to the insurance/prejudice thing. She just tells them,

"I give crappy care no matter what kind of insurance you have."

Now why couldn't I have thought of that??

The Legacy Continues

So, one of my co-workers (and best friends) told me that on Tuesday one of the doctors with whom I work had a patient with a creatinine of 32 or something crazy like that. He looked up at the nurses and said "Is that bad??"

Wa-hoo, the legacy continues!! I'm going to be famous someday mark my words:)

I love...

I have the best husband ever. The kids woke at 5 am this morning. Both of them.

Donnie got home from work at 7:30 and let me go back to sleep. I just woke up now (it's 11:45). I feel like a new woman.

Off to work for 3-11, so that feeling will last for the next few hours until my job sucks the life from me. Or, as the eternal optimist I am, I will look at it with half full eyes. It's going to be a great day. Hope you all have one too!

Weekend off, trying to catch up on my sleep...

Guess what time the little ones woke today??? Yup, you got it- 4:30. It was a loooong day and now I'm more tired than if I'd worked a double on a holiday weekend. I'm going to watch 24 and go to bed. Hope you all had a good weekend.

Fuzzy Books

Wednesday, June 14th will go down in my own personal history book as the worst day I've had in the ED thus far. I won't go into details because it's just too long and boring to recap, but the short version is as follows. We had waaaay too many sick patients (by which I mean our acuity was a lot higher than normal), way too many non-sick--but vocal--patients, and not enough doctors or nurses. By 2330 all of our rooms were full, three in the hallway (which is a lot in a 12 bed department) and 9 to be brough in. And we're a small hospital, there's only one doctor after 2200 to see all of these patients! So at 2345 we went on diversion and it somehow all got better. Of course, I didn't end up getting out until 0130 but whatever.

Oh yeah, then on my way home I came across a car off the road. He wasn't moving, or seatbelted, and his foot was wedged on the gas pedal so the tires were spinning. I called 911 and didn't get out of my car until other people arrived at the scene (reminder to myself; call my EMT instructor and thank him for teaching me about scene safety because it kept me from running to the car to assess the patient. Because, come on, I'm young, very blonde, and cute...someone could have had his way with me then killed me and no one would have known. Or his car could have exploded, leaving my kids mommyless and my husband alone. Or the car could have taken off into the woods with me hanging from the window. Or it was an elaborate set-up to rob me of my Mazda Protege-haha. Sorry, I digress...) Turns out that the dude in the car was drunk (shock!) and had passed out at the wheel. So I guess no one was trying to have his way with me. Sigh :)

And this is all what this blog is about because I came home from that night, got into bed at around 0215 and right as I was drifting to sleep Lily (the 2 year old) awoke screaming because her teeth hurt (she's cutting 4 new teeth). It is so crazy for me that I went from taking care of a 650 lb man (I'll write about him sometime) to reading fuzzy books with my daughter in the span of a few hours. I know there are many working mums and dads out there who switch the gears from work to home very quickly, so it shouldn't be anything special that we nurses do it. But to me, it is. We take care of the sick as we would our children, or husbands, or mothers and it's just what we do. Even on those horrible days in the ED when I'm considering looking up the nearest Borders to see if they're hiring, I really don't think that I'm cut out to do anything else. How sadistic is that?

When I first started in the ICU I used humor a lot with my patients. I began developing this skill when I worked at the video store and was able to size people up within a few seconds of meeting them. I could feel out who was and was not one of those with whom I could joke. So it comes as no surprise that I am slowly becoming famous for my line, "Is that bad."

The first time it just popped out. It was one of those first nights that I flew solo in the ICU and we had a code. When we had worked on the patient for over 40 minutes we were all looking at an asystolic rhythm on the monitor there was a pregnant pause. It was that pause that usually happens at a code when everyone is silently thinking that we just should call it, it's over, and then usually someone verbalizes that thought. Well, in this case, I took one look at that rhythm and blurted out, "Is that bad??"

In hindsight, it was very inappropriate for me to say something so horrible at that time. But what happened was that everyone laughed. It did something that I now realize is very important to keeping your sanity in nursing, it broke the tension that hovers over our head every moment we're dealing with the sick. And it is sick isn't it? That we make these jokes and laugh, but if we didn't we would all go crazy and this job would eat us alive.

So...now I have moved on to the ED. I hear from my old pals in the unit that when something really horrible happens that someone usually says my line in private to the other nurses and doctors. I feel like a celebrity.

Which is when I realized that this line has followed me to the ED. My co-workers are always approaching me with the line. "Cas, your lady in 8 has a K of 9.4...is that bad??" for example, or, "The police are bringing in a man who tried to kill his ex-wife and her dog at the Rite Aid...is that bad?"

It's a great line. So, if any of you out there are feeling sassy some day, try to use it. It's really amusing to watch the person you're asking the question to think that you're a complete moron one second and then realize you're only kidding in the next moment. Just make sure you know who you can say it to, or it could land you in a whole pile of trouble :)

Bed Crisis and the Weekend

Wow, sorry everyone. Busy week. Here's a recap of the last three days.

Friday: It's been raining for a whole month now. Seriously. We packed up the kids at 8 am (after I worked 3-11 and slept from 1-6) and went to Target and Home Depot just to get out of the house and see new scenery. Home, nap time for both babies, then my nephew's 2d Birthday party. Sleep that night from about 10-6.

Saturday: Husband worked this day (And for those who don't know, firefighters work a 24 hour shift, so therefore, he is gone from 6:30 am to 7:30 the next AM...means I'm on my own with the two tater tots). I packed the kids up and took them to stepdaughter's lacrosse game. Oh yeah, and on the way home from the lacrosse game my 2 year old hit me so hard in the face that my glasses flew off my body and landed on the floor of the car. I know that I am against child abuse with every bone in my body but I swear I have never been so close to hurting another human being in my entire life. Anyway, then my father picked up the tater tots at 2:15 and I had an entire 15 minutes to myself, so I read a magazine before jaunting to work. I worked 3-11. We usually see a patient volume of 55-60 per day, this night it was 71 patients. BUT, we had such an effective and great crew working (and beds in the hospital!!!!) that the shift went well. Oh yeah, then I went out with a few girls from work for ice cream, got home and was in bed by 1 or so, sleeping by 2.

Sunday: Woke at 0600 with the 2 year old. She's getting two teeth and is constantly demanding medicine (She's totally that kid who would drink an entire bottle of ibuprofen if she found it hanging out in the open. I have to watch her like a hawk) and she had 4 temper tantrums before her brother woke up at 7. When my husband got home we packed them up in the double jogger and took them for a walk. En route, we picked up an ice cream cake for my step-daughter's 10th birthday party and came home. Long story short (too late, I know), there were 20+ people at my house including 10 kids, 4 sets of in-laws, and my huband's ex-wife. AND, the party was great...everyone got along and had a good time.

Then the sun came out at 2:15, just in time for me to go back to work. Tonight was unusually slow until 2115 when the whole town decided that it was time to head on in the the local ED. My last patient of the night had just run himself into a tree after drinking "I have no idea" how many drinks (Which we all know is really bad when they don't say "two" or "a couple" and actually admit to being intoxicated.) He told me that I was adorable and if we were in a bar he would totally try to pick me up--would I let him pick me up???? To which I answered, a blunt and direct, "Not a chance in hell" and he laughed.

So now, here I am writing on this stupid blog that I don't think anyone reads instead of sleeping. Sigh.

If there is anyone out there here is my question of the day:

Are we the only hospital out there with a bed crisis or is this a problem that we're all dealing with???

Videos and Gift Cards

I sometimes wonder if I've chosen the right path for my career. I went to a small liberal arts college in the middle of New Hampshire. My graduating class was 8 students total. We were considered "dorks" in our school becuase we studied a lot a socialized very little. Before I graduated I had three job offers, two being in ICU units. One was at a level 2 trauma center in the adult ICU, the other at a small community hospital with an 11 bed ICU.

I chose the community hospital because of two reasons.
1. I'd worked there for a few years and already knew a lot of people. My mother worked in the ED at the time and I had grown up there. So, I already fit in, and was accepted, a huge hurdle in my opinion.
2. At the big teaching hospital I was told in my interview that their #1 problem in the unit was nurses "eating their young." In addition, one of the newer nurses had pulled me aside and told me to watch my back. Yikes.

I wonder what would have happened if I had gone there instead of where I am now. I know that I would have learned a lot, but would I have come out on the other side a different nurse, or even person, for that matter? I am not the kind of person who fares well in a harsh enviornment and I could see working at such a hostile place turning me off from nursing all together. If that happened, what the hell else would I even think of doing?

Which leads me to this question...almost all of the nurses I know LOVE what he or she does for a living and yet all of them will tell you in the next breath what s/he would do if money was of no issue. So, if anyone is out there reading this stupid blog I want to know-- what would you be doing if money wasn't a factor? Here's what I would do:

I would own a video store. I would have very loyal and interesting clientel who would come in on a regular basis and hang out in my store. We would be buddies. I would work 6 hours a day and spend the rest of the time with my two little friends and my husband. When I made enough money to pay off my store I'd open a little gift shop with fun little things and cool jewlery and notepads and pens, or stupid wall hangings and perverted gift cards and work there a few hours a day. There would be time every day to work out, watch a movie AND read a book, sleep in late (or at least until 6:30 am) AND have supper with the family and play a board game after we ate. Sounds great huh?

But here's the thing...

But here's the thing...
I left work last night around 11:30 pm, got home and to bed around 1:00 am (because, come on, who can go right to bed after working as an RN...it's just NOT possible). The baby woke up at 2:15 am and then at 5:15 the 2 year old woke up. So today, as you may have guessed, I am sooooo tired. And, so are my kids (And just so you all know, I'm a sleep drill sargent. My kids are great sleepers but with all of this rain and not playing outside and growth spurts they are all over the place with their sleep habits right now. Just one more thing to push me right over the edge).

Luckily my husband didn't have a single call at work last night and he slept like a baby from 9-6:30. I hate him right now.

But isn't it just nutty how you can shift from taking care of a 75 year old woman with a PE and go home to feed the baby and watch The Wiggles? I think that is so cool!

Whew!

Don't worry everyone, he made it home OK. :)

Supersitions

I am going to become a millionaire writing my book about supersitions in the hospital. Are these everywhere or just where I work? (Haha, I bet that's a silly question)

When I was in the ICU if we got a room ready for an admission and if that patient never was admitted you could NEVER touch that bed or bad things would happen. At night, if there was a light in an empty room you couldn't turn it off or someone would DIE!!!! In the ED, if our census board is ever blank the world will flip on it's side and we will all float away into the vast black eternity. And we all knows what happens if someone says the Q word. NOoooo!

So you can all understand how scared I was this morning when my husband couldn't find his necklace that he wears every shift to the firehouse. Our two-year-old had been playing with it yesterday and neither of us thought to take it away from her. I was so nervous that I amost couldn't think straight. Luckily, he has a back up necklace that pinched hit for him. I can't wait until 7 am when he gets off.

Can I Start Being Selective???

I remember this psych patient we had a long time ago who refused to speak to anyone who wasn't Catholic. She ended up escalating and calling us all sinners and refused to speak to anyone who isn't her chosen religion.

It got me thinking...what if we could be selective of the patients whith whom we speak and care for. Just all of the sudden we decide that today we refuse to take any patients with chest pain. Tuesday's are off limits for anyone with a dental complaint. Oh, and I'm sorry sir, we don't accept anyone with grey hair and lacerations today, come by tomorrow and we'll fix you right up.

The ED is a place that is open to all. Our hospital is a small community hospital in Maine and our inpatient units are failry selective of the patients they accept. Med/Surg is great, but is it a daily struggle to get ED patients into the ICU and Behavioral Health units.

But we can not chose the patients we see, nor can we shut the doors when it's just too much like other units can. We must stack them in the hallway, double up family members, run tests from the waiting room and every other creative idea we come up with to see more patients and see them as quickly as possible.

And I love it. How strange is that?

Wow

I am going to use this space to talk about my life...

I'm 25.
I have a husband who is almost 10 years older than I, and we are in love deepy, madly, and happily. He is a firefighter/paramedic.
I have a 2 year old little girl and a 9 month old little boy.
I work full time in the Emergency Department at a local hospital in Maine.

And I'm fucking exhausted. Anyone else out there with a loaded plate?

I am going to use this space to talk about my life...

I'm 25.
I have a husband who is almost 10 years older than I, and we are in love deepy, madly, and happily. He is a firefighter/paramedic.
I have a 2 year old little girl and a 9 month old little boy.
I work full time in the Emergency Department at a local hospital in Maine.

And I'm fucking exhausted. Anyone else out there with a loaded plate?