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.

Really?

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.

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.

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.

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?

Pulseless Electrical Activity

Courtesy of Wikipedia -Pulseless Electrical Activity or PEA (also known by the older term Electromechanical Dissociation or Non-Perfusing Rhythm) refers to any heart rhythm observed on the electrocardiogram that should be producing a pulse, but is not. The most common cause is hypovolemia.
The approach in treatment of PEA is to treat the underlying cause. These possible causes are remembered as the 6 Hs and the 6 Ts.

• Hypovolemia
• Hypoxia
• Hydrogen ions (Acidosis) *****
• Hyperkalemia or Hypokalemia
• Hypoglycemia
• Hypothermia
• Tablets or Toxins (Drug overdose)
• Cardiac Tamponade
• Tension pneumothorax
• Thrombosis (Myocardial infarction)
• Thrombosis (Pulmonary embolism)
• Trauma (Hypovolemia from blood loss)

A patient in their 50’s had been in our ER all day with abdominal pain. The person was finally rushed to surgery after 5 liters of IV fluids, and a levophed drip could not get their blood pressure out of the toilet.
A large length of gangrenous, dead bowel was discovered during the lengthy surgery. It was removed and a colostomy was made. The patient came to Recovery with much better blood pressure.
Although the patient was on a ventilator, we noticed they were starting to look a little blue.   They had a normal looking rhythm on the monitor. However the pulse weakened and then stopped. PEA. Call a code. Start compressions.
It turned out the patient was extremely acidotic*** and ended up getting 4 amps of bicarb in addition to the 2 during surgery that they had gotten. A pulse returned. Not out of the woods for sure, but able to go to ICU at least. I checked when I came in the next evening. The patient was still alive.