Wednesday, December 29, 2010

Do Unto Others...

   The other night I was in Phase 2 Recovery. This is typically a piece of cake gig, a short stopover before the patient gets to go home. It is kind of like working Fast Track in the ER, all about moving patients in and out as quickly and as happily as possible. You only get stable patients from the main Recovery Room, or with some minor procedures, straight from the OR. Phase 2 has recliners, warm blankets, and yummy stuff to drink. It even has a fancy menu, ie. saltines, graham crackers, and broth. Each small bay has a chair for a family member to sit and visit with the patient until it is time to go home, typically after 30 minutes to an hour or so.
   I was breaking down a chart when I heard some commotion from the other side of the room. A very experienced Recovery nurse was telling a new nurse she was going to call the doctor "right now". I walked over to see if they needed help. The patient was on a stretcher. He was a male in his 40's, vacantly staring into space. I tried calling his name and doing a sternal rub with no response. We got him on the cardiac monitor and pulse ox. He had loud, irregular, snore like respirations. I attempted a head tilt chin lift to open up his airway more. His neck and jaw were stiff and uncompliant. I noticed his sheets were soaked through with urine. A CNRA arrived, inserted a nasal trumpet and started to bag him. I got the code cart. The Anesthesiologist got there and had me give the patient an amp of Narcan with still no response. The code team burst into the room and got to work. The Intensivist and the Anesthesiologist conferred on the situation. The patient's pulse was getting fainter and fainter. The Nurse Manager walked into the bay and informed me that I was going to need to take care of the patient's crying wife.
   Holy crap. In the ER we had patient reps who sat with family members. On day shift we had chaplains.  I looked at this pale, scared woman and thought that I would rather do a thousand chest compressions than try to comfort her. So, I walked over and put an arm around her, leading her out of the crowd gathered around her husband.
   I felt completely helpless and inept. She was crying and asking me if he was going to be okay. All I could say was that the team was doing all that they could. We prayed together. We talked about how they had met. She kept repeating "I can't lose him. I can't lose him". I held her hands, and we prayed some more. I could hear them starting chest compressions. I heard someone talking about PEA and V-tach. I heard the distinct sound of a defibrillator charging. When she heard a doctor yelling "Clear", her face drained of all color and she ran back to the bay with me in tow. One of the doctors present told me to get her into another room. Not everyone in the hospital is on board with family presence at codes.
   This woman obviously loved her husband very much and started to become agitated when she was advised to step out of the area. Right at this time Dr. J walked in. He was a partner of the surgeon who performed this patient's very minor procedure. Dr. J  was on his way to Preop to see a hip fracture patient. He immediately took in the situation and acted quickly with no hesitation. He could have just passed through with no comment as another partner had done. However, he headed straight for the patient's wife. Doctor J took her hand and introduced himself. He explained to her in simple terms what the team was doing and why. He sat with her for several minutes while she cried on his shoulder. He escorted her to her husband's side when the intensivist was about to call the code. She sobbed and cried for her husband to come back to her. Doctor J held her hand and then brought her back to me when he had to leave for the hip surgery.
   The patient's wife retreated to a private room to make phone calls, with me and her husband's surgeon occasionally checking on her. The actual surgeon was deeply shaken, stating he had never lost a patient before. The anesthesiologist who had been the first doctor on the scene looked devastated. He asked me if the wife knew that they had done absolutely everything they could. The patient's wife came out briefly to let us know that she was declining to pursue an autopsy, that she wanted her husband's body "left alone". She told us that her son was on his way to get her and take her home.
    Dr. J returned to the area briefly after a very quick hip pinning. He went with the wife to see her husband's body one last time before she left the hospital. Some staff were complaining that before he took her over to see her husband, Dr. J had removed the endotracheal tube from the body. However, since no one, including the Medical Examiner, wanted an autopsy, I guess maybe it didn't really matter. I believe that he was trying to make the situation easier for her to bear. An et tube can be a jarring sight when protruding from the mouth of someone you love.
   When the adult son arrived, the patient's wife gathered her things. She asked us to make sure her husband had a blanket, that he hated being cold.
    I said goodbye with a hug and a "God bless you".
   The next evening I saw Dr. J again. I thanked him for his help and told him that for a surgeon, he was a pretty good guy. He appeared genuinely perplexed by this and asked why. When I explained how much his involvement had meant to the patient's wife, he still looked puzzled. He stated "It's what I would want someone to do for me". I smiled and thanked him again before he left for the night.

Tuesday, December 28, 2010

Vintage Bedpans

 I think every nurse sometime in their career, usually many times in their career, has provided a bedpan to a patient. Or held an emesis basin while it was filled up with vomit. Or at least hopefully, if the patient did not miss and get the nurse's shoes instead. The crisp white uniform and cap have (at least in the U.S.) gone out of style, but some aspects of nursing are definitely timeless.

Saturday, December 25, 2010

I'm No Paula Deen, But...

These are seriously the best things I have ever eaten. I took them to my work, and they disappeared in minutes. I had never made anything from scratch in my life, but it was not even that hard. Trust me. I am no expert chef, but I love to EAT. And don't get upset that I'm promoting obesity in our already overweight and sedentary society. Just don't eat them all yourself. Share with a buddy. Moderation, people! Awesome stuff.

Symphony Brownies
Yield | 12 brownies

4 ounces unsweetened chocolate; coarsely chopped
3/4 cup butter
1 ½ cups white sugar
3 eggs
1 teaspoon vanilla extract
¼ teaspoon kosher salt
1 cup all-purpose flour
2 (4.5 ounce) Symphony Chocolate bars; broken into squares

1. Preheat oven to 350 degrees. Line an 8×8 inch baking pan with foil and spray with nonstick cooking spray.
2. Microwave chocolate and butter or margarine in large bowl at medium (50% power) for 3-4 minutes or until butter is melted.
3. Whisk until chocolate is melted. Stir in sugar and add in eggs, extracts and salt. Gradually add in flour and stir until just combined.
4. Spread ½ the batter into prepared pan. Add an even layer of Symphony Chocolate squares and cover with remaining ½ of brownie batter. Bake for 30-35 minutes; do not over bake.
5. Remove to cooling rack. Allow to cool completely before cutting.

Inspired by Paula Deen and adapted from allrecipes

Friday, December 24, 2010

A Wiggly, Licking Homecoming

At the Holidays when you are cozy in your home with your family, remember those who are away from their loved ones doing an often thankless job, dedicated to keeping their country safe.

Alert and Oriented x 1

A patient wakes up in the Recovery Room
"Where am I" he asks.
"You are at the hospital. Your surgery is all done" I say to him.
"Where am I?"
"You're at Crazyland Medical Center" I say.
"But, where?"
"Gigantic City, Florida" I tell him.
"Is this Earth?"

Monday, December 20, 2010

The Original Christmas Story via Facebook

I hope my Non Christian friends will excuse a brief foray into the origins of Christmas, as told through Facebook. I thought this was quite clever and sweet.

Friday, December 17, 2010

Random Musings AKA Too Tired to Write Anything Coherent

Passed ACLS yesterday. Even though this is the 3rd time I have taken it, I always get nervous and am afraid I am going to fail. I feel like an imposter in there with all the ICU and Cath Lab nurses. But I actually had no trouble at all passing because the material was extremely fresh in my mind. We had the most unexpected, most draining, marathon code the night before. That is definitely a story for another day when I am more awake.

I also attempt every year to use trauma shears to cut Holiday wrapping paper. They work great on patients' clothing, but not so much on my delicate Christmas tree covered gift wrap. Go figure.

Bought the Lego Airport set for my 9 year old. 99 freaking dollars for Legos! Seriously. I ...have...lost She still writes a letter to Santa, though, so it's worth working a few extra hours for some overpriced plastic blocks. You gotta be able to rely on Santa.

My 12 year old wants a cell phone. Some of her friends have had them since third grade.

After ACLS I stopped by Preop Holding as I was advised to by my Manager  "Just to make sure they don't need you. The surgery schedule is fairly light in the afternoon and evening tomorrow. I'm sure they will just send you right home". Uhhhh. Yeah. Not so much. The good news is that the Lego Airport is now paid for and then some. But every floor patient we got was starving, grouchy, on isolation and had an infiltrated IV. Fortunately everyone was stable and had a vein for me to stick, and all turned out well. One elderly hip fracture patient was scheduled to be operated on by the infamous Dr. Handsome. Fortunately his semi handsome, but extremely easygoing and kind partner showed up to perform the surgery.

Made my first ever brownies from scratch. Delicious! Have pumpkin cheesecake with streusel topping cooling in the fridge right now. Heavenly. Feeling warm and blessed to be home with my family.

Tuesday, December 14, 2010

It's Not All Sunshine and Lullabies

   -L & D is not always the happiest place in the hospital. Consider the case of Ms. H. Ms. H is a healthy 35 year old female, at 28 weeks gestation with her 3rd child. Thus far the pregnancy has been uncomplicated. One Friday morning, on her way to work Ms. H notices that the baby, a girl, is not moving as much as normal, so she calls her OB and arranges to come by for a quick check. Ms. H's BP is up and her weight has gone up several pounds, much of which appears to be edematous. The doctor checks the fetal heart rate, which is 127. He offers her the option of going to the hospital for an ultrasound, which Ms. H accepts. The hospital can't get her in for several hours, so the office nurse advises Ms. H to go home and try some caffeine to get the baby moving.
    After waiting at home and still not feeling the usual amount of fetal movement, Ms. H drives herself to the hospital for the ultrasound. When the tech begins the ultrasound, she quickly stops and steps out to answer the phone, stating that the secretary is gone for the day, so she has to help at the front. The tech is gone for an unusually long time. Finally the tech comes back in the room accompanied by Ms. H's OB. Ms. H immediately bursts into tears, sensing that whatever is coming is going to be unbearably painful. The MD takes her hand and simply says "It isn't good". The baby was dead and possibly had been dead for quite some time. The doctor gives Ms. H some options. She can go home, pack and come back the next day for induction of labor or she could go up to the floor immediately to start the process. He explains potential complications: infection, bleeding, DIC. He offers to order her Ativan and Ambien. Ms. H decides to go up to the floor for immediate induction.
    The OB accompanies Ms. H upstairs and promises to call her husband, as she is still quite tearful. The doctor leaves to go write admission orders. Elizabeth, a veteran L & D nurse from Ireland, appears and gives Ms. H a hug. She gets Ms. H settled into a room, obtains a urine sample, and applies the ID bracelet. Soon it is shift change. Stacey, another veteran L & D nurse, introduces herself to Ms. H and hugs her also. Stacey inserts an IV and draws blood in a rainbow of tubes for stat labs. The OB returns and inserts Cytotec into the vagina to initiate the induction process.
    The lab results come back quickly. Ms. H's white count is high. Her platelet count and RBC's are slightly low, and her liver function tests are abnormal, not the best findings. The OB orders two IV antibiotics to counter any infection that is present and then  leaves the hospital for the night. Ms. H's husband arrives amidst more tears. The nurses contact a representative from a local support group for parents of stillborn infants and infants who die shortly after birth. The representative will later come visit Ms. H in the hospital.
Because of their other children, Mr. H has to leave for the evening. Stacey gives Mrs. H an Ambien and checks on her periodically throughout the night.
    In the morning an infusion of Pitocin is started by Elizabeth, who has returned for the day shift. Elizabeth also hooks up a Dilaudid PCA, so that Ms. H will have some pain control. Ms. H is alert and oriented and occasionally tearful. Her spouse stays with her throughout the day. Elizabeth assist Ms. H in filling out the forms required for a death certificate. Ms. H names the baby Anna Elizabeth. As the day shift goes on, contractions begin and eventually grow stronger and more painful.
    When the night shift staff comes on duty, Stacey returns along with a new grad RN, Candace, to take over care for Ms. H. The PCA is no longer providing sufficient pain relief. The nurses suggest an epidural, to which Ms. H readily agrees. Sheila, the charge nurse, comes in to help set up for the epidural. The Anesthesiologist arrives and coaches her CRNA student through inserting the epidural. Ms. H relaxes considerably once she obtains adequate pain relief. The OB returns and decided to do an amniotomy, breaking the water. Once the doctor leaves, the contractions increase in frequency and strength. Stacey, Candace, and Sheila all are present to deliver the stillborn baby.
    The nurses whisk the baby's small body off to the next room, where they clean her and wrap her in a blanket. The nurses obtain her handprints and footprints. They put a hat on her head and take photos of her. Then Stacey and Candace take the baby to her mother.  Tears stream down Mrs. H's face.  Ms. H holds her baby and looks at her lovingly for a very long time as if trying to take in all the details and commit them to memory. The baby has fair white skin and lots of dark hair. Her eyelids are still tightly shut.
Eventually the nurses take the baby back, and Candace takes her body to the morgue. Stacey gives Ms. H an Ambien. The OB arrives back at Ms. H's room and delivers the placenta without complications. Ms. H's husband returns home to their children. Stacey and Candace pop in at least hourly throughout the rest of the night to assess Ms. H's mental and physical status.
    In the morning RN Elaine takes over Ms. H's care. Elaine has been in L & D for 30 years. Ms. H's husband and other two children are present at the bedside. Ms. H requests a chaplain to pray with them. Elaine asks if she would like the baby present for the prayer. Ms. H considers this and agrees, stating "Maybe it is the only thing I will ever be able to give her".  It is a Sunday, so the main hospital chaplain is presiding over mass at his home church. Elaine calls and calls, everywhere she can think of. There seem to be no available ministers anywhere in the entire metropolitan area. Eventually a tall, bald man wanders into the room, introducing himself as one of the hospital's assistant chaplains, stating he had just stopped into the office for a moment and saw the message. Elaine brings the baby to the room, and the chaplain and  family hold hands and pray. The two other children, 7 and 9, appear interested in the baby and both hug her. The chaplain leaves, and Elaine returns the body to the morgue,where an autopsy will eventually be performed. Elaine Brings Ms. H a decorative box, which contains a sympathy card signed by the nurses, the baby's blanket and hat, copies of the footprints and handprints, as well as the photos. Ms. H is discharged to home at approximately 1500. -
    These were some damn good nurses, who did their utmost to make a horrendous, heartbreaking situation at least somewhat bearable. I was not one of the nurses this time. In fact, I was the patient, Ms. H. Being the patient totally sucks, but when overcome with grief, it is excruciating. Those nurses gave me 100% and I took it greedily and gratefully. Now when I give a hug, hold a hand, or look in a face contorted with grief and pain, I draw on what those L & D nurses gave me in the midst of my deepest, darkest moments. Their love and compassion flow through me to my patients as though from a well that never run dry.

    **One year and 3 months from the date of the loss of Anna, I gave birth to a healthy 9 lb baby boy.
Life is good**

Friday, December 10, 2010

Is It Just Me?

I used to eat no red meat...until I married my husband. He loves steak, hambugers, roast beef, ground beef, beef of all sorts. So, I learned to prepare dishes with various forms of red meat. I noticed something. It hit me very strongly today as I opened a package of steaks to marinate. Is it just me or does raw beef just slightly give off a hint of fresh GI bleed smell? Ewww.

Thursday, December 9, 2010


Was it really necessary to put a 95 year old under general anesthesia and perform an exploratory laparotomy just to dignose a fecal impaction? Just asking.

Tuesday, December 7, 2010

What an Interesting Hospital!

Awww....poor Jane.

Hugs And Kleenex

When I was working as an ER Tech during nursing school, I had the pleasure of meeting a great nurse named Johnny. Johnny had immigrated from Laos as a child and had a great perspective on life. The night I met him we were struggling with an elderly lady who had a severe reaction to Phenergan. She was post fall and having nausea, so the Dr gave her Phenergan, which immediately made her totally crazy and extremely strong. My job was to take the combative patient to CT, put on a lead apron, and make sure she stayed still for the scan. In addition, I was charged with keeping her grown daughter calm. Johnny watched me and talked to me about it during a smoke break: he smoked and I listened to him talk. He said that he could train a chimpanzee to put in a Foley or start an IV, but compassion was not so easily taught. He told me he thought I would make a good nurse, precious words for a nursing student discouraged by intimidating professors.
At times I think compassion is underrated, sometimes even disdained. Nurses can often be sarcastic and snarky when we talk about supporting patients emotionally or bonding with patients. I've gotten the "Well...I wish I had time to just sit and listen to patients talk, but I'm busy actually giving care" from other nurses, as if all I do is sit around and chat and neglect my other duties. We are of course encouraged to be nice and empathetic in nursing school, but also to keep a professional distance. As NurseXY mentioned in a recent blog, this professional distance is taught early on in order to ensure that our decision making abilities are not clouded by our closeness to the patient. I can see the point, but I think, as he wrote as well,  for many nurses it is sometimes impossible not to get emotionally close to a patient, especially if you are dealing with them in a setting where they are with you for weeks or months.
I have worked in ER, Preop, and PACU, places where we are with patients for a matter of hours, not days. However, we are with them at such a vulnerable time, where emotions are heightened considerably. We have interactions that I will certainly never forget.
Just this past Friday I was present when an elderly woman had a conversation with her daughter, son, and pastor debating whether to have surgery or if it was time to just stop fighting. All I did was provide the Kleenex and some hugs, but it was a privilege to witness the love and strength of this family.
That same day I took care of a man who came directly from his family doctor's office to the hospital to have major stomach and colon surgery, definitely not how he had been planning to spend his day. He was keeping up a stoic appearance. His wife walked over to the side of the room to use her phone to notify family members of the situation. I noticed that she had stepped over to the entrance of the unit to where the curtains were blocking her from her husband's sight. She was quietly crying. I went to her with Kleenex (again). She told me that she was just in shock and could not imagine losing her husband. I hugged her and just listened. It is an honor to help hold people up in their time of crisis and need. I am in awe of the fortitude of so many of these patients and their families. If I can provide just a tiny bit of support, just a little bit of warmth to help fuel them through this incredibly challenging time, I am privileged beyond belief.

Saturday, December 4, 2010

Dr. Handsome Throws Another Fit

I had hoped that Dr. Handsome's tantrum, about which I wrote earlier, would turn out to be a rare occasion, a brief moment of temper not to be repeated anytime soon. Yeah, I was wrong. The last time I had encountered the pretty to look at Dr. Handsome had been in Recovery. This time it was in Preop. He had a patient with a hip fracture, a gentleman in his 80's. The patient was on an Amiodarone drip and had pacer pads on. His telemetry nurse walked down with him, which typically only the ICU nurses do. This guy obviously had some cardiac issues. Dr. Handsome had requested a Cardiologist consult for cardiac clearance, covering everyone's butts if this guy had problems during surgery. Well, apparently the Cardiologist's report was too ambiguous for Dr. Handsome. It simply stated that the patient was a surgical risk. He threw down the chart with a clatter and started raising all kinds of hell at any nurse within his visual range. He demanded that a nurse get the Cardiologist on the phone, so we did. The Cardiologist seemed genuinely befuddled by the conflict. Finally Dr. Handsome had to get on the phone and ask for a more specific endorsement of the patient's suitability for surgery. His voice and manner did get slightly nicer while he spoke with the other doctor. Dr. Handsome then ordered that a nurse get on the phone and write down word for word the cardiologist's statement because of course he could not lower himself to write them down himself. So I wrote down. "Patient is cleared for surgery however presents significant cardiac risks". Apparently this satisfied Dr. Handsome's cover his butt instincts. He examined the order sheet (I guess just in case I had mischievously written down something different), threw down the chart AGAIN, and stalked off to the mysterious realm of the surgeons' lounge. The patient made it through the surgery.