Recovery Room Quote of the Day

A cranky older gentleman when informed that he must wait until he is transferred to Phase II recovery to get dressed and leave:

"You call this a hospital? It's more like a laboratory."

Follow up: In my report to the Phase II nurse, I mentioned that the patient was "a little grouchy". The Phase II nurse stopped by later and accused me of giving her a grossly inaccurate report. She said "Grouchy was not the word. That guy was actually an asshole".  Ahhh...technicalities. Tomato/tomaahto. I guess one person's grouchy is another person's asshole.

Busy

I have not posted in awhile and am full of excuses:


 1. We have had  a mass exodus of nurses, respiratory therapists and techs from my somewhat hoodish hospital. Beautiful -New -Suburban -All Private -Room -Hospital -With -A -Gourmet -Chef has siphoned quite a bit of our staff away. Shortstaffing has led to chaos and lots of overtime for everyone.

2. My professional mentor was fired recently (a blogpost for sure when I get the emotional distance to write about it), leaving me sad and discouraged. I do know, however, that if Florida had unions, it sure as hell would not have happened.

3. PACU traditionally consists of 4 ten hour shifts a week, plus weeknight and weekend call. We have had a few nurses leave who want to go back to the 3 12 hour shift workweek. More overtime for me!

 4. When I get home, I want to play with my kids and sleep. I know I need to exercise, but soooo tired. Maybe I will lay my head down on the table right now........................................


 

A Weighty Issue

 I checked out a new blog today and saw a blog post after my own heart. My fellow Recovery Room nurse put into words a conversation I have had with several patients. At http://recoveryroomriley.blogspot.com/2012/01/worn-out-joints.html this nurse talks about how an obese patient cannot for the life of her figure out why all of her weight bearing joints are deteriorating and need to be replaced.
I have noticed this same thing with many of my patients. They do not understand why they need to get their knees and/or hips replaced, why they are hypertensive, why they have lower back pain. Many do not even realize that they are obese. Are their physicians not discussing this with them? Now keep in mind that I am not talking about the pleasantly plump individual or the person who has "a little more to love". The patients to whom I am referring are truly in the category of obese, sometimes morbidly so. And it is not just the patient's health that is affected. Every time they pull a 400 lb patient up in their bed or transfer a 350 lb person from a stretcher to a bed, health care workers sigh in relief when their backs emerge unscathed.
  How do we  get the collective American waistline to shrink a bit? This gentleman at CNN compares the response needed for this issue to the war on smoking and even more so to the campaign to reduce highway fatalities  cnn.com.        
  Now my muffin top has grown from barely noticeable to semi-in-your-face over the holiday season, so I am  certainly not immune to the pleasures of pumpkin pie, fudge, and cookies. However, seeing the debilitating health issues that my obese patients face absolutely does help motivate me to not let my weight get too out of control, kind of like old ladies with broken hips inspire me to take my calcium. It is hard in a world where processed, sugary and fatty food is less expensive than fresher, more nourishing choices to always do the healthy thing. However, if we can just get ourselves to the the healthy thing a little more often, I think we could make some giant gains...or giant losses in this case.

So Sweet

I never used to be a big crier. Maybe I need to up my Zoloft or maybe I have a hormonal imbalance. I'm not sure... but this story brought tears to my eyes.
http://mommyish.com/stuff/parents-get-insulin-pump-tattoos-to-support-diabetic-child-947/

Solid Gold

I had an elderly female patient in PACU yesterday, who had just gotten a knee replacement. As she was being hooked up to the PACU monitors, her gown got a little sideways, briefly exposing her nether regions. We immediately covered her with a warm blanket as she burst out laughing. "Girls" she cackled "you best not show that to the crowd. It'll blind them. It is solid gold!"

Question of the Day

This question was posed to me by a brand new nurse, but is something that I have also wondered about in the past.


"Why do so many Respiratory Therapists smoke?"


Any ideas?

The Scary Dad

Whenever I work in Preop Holding, something weird or confusing seems to happen. Last week I had a patient coming from our ER.  The patient was a 4 year old boy who had stuck a tiny Lego bit up his nose. The ER doctor and the ENT on call had been unable to retrieve the errant Lego in the ER, so surgery was scheduled for the little guy. Fishing out foreign bodies from various bodily orifices is a pretty common activity in the surgical suite, so as is the routine I called the child's ER nurse for a quick report. The nurse was obviously an intelligent woman, giving me an excellent detailed report. Now I admit I am biased towards ER nurses. They do it all, do it fast, and often do not get the repect they deserve. I started out in the ER and still see pretty much everything through that perspective. But this nurse went off on a lengthy tangent that freaked me out a little bit. She started talking for a while about how the father of the child was a militant "foreign" Muslim who hated white women and was disrespectful to the female nurses. "You know how they are." she said about male followers of Islam.
  It was an unusual way to end the report, so I figured this guy must be a real terror. I immediately pictured a bearded man screaming in a foreign language at the staff. Imagine my surprise when the man in question turned out to be a pretty ordinary looking guy who spoke English well. The little boy was an absolute cutie pie. As I was getting him and his mountain of paperwork ready, I kept waiting for the dreaded misogynistic outburst from the Dad. I waited and waited. I am half Latina, with my Mom's pale Irish skin and my Dad's crazy frizzy/curly hair. So, maybe I did not count as an actual white woman. However, my coworker is a 100% lily white, sweet as pie platinum blonde Southern girl, so maybe he would direct his ire at her. Nope. He was complimentary and gracious to her as well. As I escorted him to the wating room, he thanked me and told me I had a nice personality. Religion was not mentioned by anyone at anytime. I really couldn't figure it out. I simply treated him as I would want to be treated if I brought in my child with a Lego up his little nose. Had the guy undergone a total personality change between the ER and Preop Holding? Had the otherwise smart ER nurse misinterpreted his behavior? I didn't know what was going on. It was weird.

Shocker!

Headline on foxnews.com:

"Merck Clot Preventer Linked to Bleeding Risk"
No way!!!! Really!?!?

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.

A Calling or Just a Job?

Have you ever had a really crappy shift where you couldn't find a vein if it slapped you in the face, the patients just get sicker, the pyxis had none of the meds you needed, the lab took hours and hours for stat orders, the docs were grouchy, etc. Yeah. I had one of those a few days ago. Days like this make me question if I am just too lousy a nurse to be in this profession even though I usually love it so much.

With apologies to my atheist friends, I truly believe God/Higher Power/Universe always knows how to make up for this garbage kind of day. The next shift I had some of the sweetest patients. The docs were not troublemakers. The lab was super quick with results. And the pyxis was well stocked with all the necessities. I actually felt semi competent. I had a patient's mother thank me for being a blessing to their family. Wow :)
One thing that really struck me was when a patient's daughter, a hospice nurse, told me she was thankful that her mother had gotten a nurse for whom nursing was a "calling" not just a job.

I really appreciated that comment, but it made me wonder. What is the difference between a calling and just a job? I have wanted to be a nurse since I was a child, but know many nurses who went to nursing school to please parents, to retrain after their factory job went away, or to have a way out of a bad marriage. They are excellent nurses. I certainly enjoy getting a paycheck. I don't think I would want to be a nurse for free. I do get a deep personal satisfaction when I can make a difference in someone's life or even just provide some comfort when it is needed.  What is nursing to you, a calling or just a job?

Cool

Things like this reinforce my belief in a higher power. It was the middle of the night in Recovery . We had 2 nurses tending to a patient who had just come out of a complicated emergency bowel resection and was going south very quickly. She was feverish and having respiratory distress. Of course not being able to breathe well was scaring the patient. Adding to the anxiety was the fact that she did not understand the English being spoken to her. She was a native of Haiti and spoke only Creole. No one could locate a patient rep who spoke Creole. Her family had gone home to rest. She was crying, making her struggle to breathe even worse. The Respiratory Therapist was setting up a ventilator. The anesthesiologist was preparing to start a central line.
 A housekeeping supervisor interrupted the chaos, politely asking if we would be there much longer- the floor needed waxing- and if we had any additional needs for housekeeping to address. This man had light brown skin but no trace of any accent. One of the nurses looked up from the gasping patient.
“You don’t happen to speak Creole, do you?” she asked in a semi sarcastic tone.
“As a matter of fact, I do” he replied.
Holy crap! We had a translator dropped into our laps. He spoke to the patient in soothing tones. She lit up upon hearing her native language. He explained to her what we were doing and why. She immediately calmed down and her oxygen saturation went up several points. When her anxiety lessened, her breathing improved. No vent needed after all. The central line was put in, and she was taken to the ICU.
Cool.

My New Favorite Book

I have not had a chance to read this book, but it is obviously awesome.

Frustration and Gratitude

Some days I come off of a nursing shift feeling like a total moron. I guess that is what happens when you try a new specialty. Hopefully my coworkers and managers will not judge me to be an idiot and will understand that I am teachable. I just need to learn how to do things that I have not done before and as a result, sometimes look stupid to others. So, some shifts are a challenge. However, I must say that the patients make everything worthwhile. The names fade, but the characters drift in and out of my memory:
The risque joke making, 60 something year old gentleman who joked that he wanted me to bring him a rum and coke with his percocet. He was in for terrible COPD and was a major smart ass with an obvious glimmer of intelligence, who turned out to be a former police chief of a nearby major city…
The occasionally confused woman with a broken hip who told me about her childhood during World War II. She had been visiting her relatives in Germany when the war broke out and and was stuck in Germany for the duration. She painted an incredibly colorful picture of the bombings and destruction that she witnessed. When she finally got home to the US, she had not seen her Dad in several years. She described their reunion with tears in her eyes…
The 75 year old woman with congestive heart failure who talked about her 40 years as an ER nurse. She said she wore a huge white cap and was required to stand when a physician entered the room. I was secretly thrilled when I overheard her tell a friend that she had a “brilliant nurse”.  She told me she raised 4 children, 3 of whom turned out to be nurses as well.
The elderly gentleman in for dehydration related to nausea and vomiting from chemotherapy. He talked about being a prisoner of war in Italy in World War II. Then he came home to Florida and started a successful dairy farm in what is now an urban area. I asked him how he felt about selling his land, and with a twinkle in his eye, he told me that it was worth it when he was able to buy his wife her first diamond ring after 35 years of marriage…

I may have to look stupid and ask some dumb questions sometimes, but really...it is quite a job.