Whitey Tighties & Mairzy Doats

I knew it was going to be a hysterical shift when I arrived to find the supervisor at the desk, frantically phoning for a replacement day nurse.  Within minutes, the phone--which never seemed to stop--rang again.  I was asked to take an ER report on an incoming patient.  "I haven't even clocked in!" I protested mildly.  Then the call lights started in again, and they never quit, all night long.   

I caught the squeal on the new patient.  Thanks be to God, ER had done the H&P, the off-going nurse stayed long enough to get the admitting assessment, and the patient was alert. 

The rest of the night was a blur of blood vitals and on-the-fly computer charting.  At 0600 I realized we had not had a single Code Brown.  In fact, I had found three (THREE!) patients wearing clean undies.  The one patient who did move the bowels made it to the appropriate porcelain receptacle without incident.  For our unit, this was truly astonishing.

Three of them actually slept through much of the night, but wouldn't you know the other two made up for it in spades.  IV  Lasix at 2300 is not a thing designed to produce a good night's rest.  

 

The other problem with alert patients is they are difficult to distract when you have to do something unpleasant.  This morning's patient hates injections, which are ordered q12H,  but she has that all worked out.  When the needle begins to pinch, she sings "Mairzy Doats"...out loud!  She was delighted when I sang along;  my Grandmother was quite a fan of Mairzy Doats.  I know all the words.  End of Nasty Injection Time.

Don't you think we ought to adopt Mairzy Doats as the unit theme song?

Molly & Me

I'm still in the breaking-in phase of work at Li'l Old County General.  For me, that has included finding efficient ways to do patient care and chart it without running behind.  I've solved most of the task tracking and equipment issues by developing my own version of a flow sheet and carrying a basket with med administration items.  There is (almost always) a roll of my favorite adhesive tape in there.  I couldn't do nights without my trusty penlight.  People chuckle at my blue basket, but it works.  

Now I have the latest improvement; Molly the COW.  Our unit has numerous portable laptops on Stinger bases.  These allow you to wheel the computer wherever it's needed, raise it to stand and lower it to sit while typing, it has wireless computer interface, and some have an on-board barcode scanner.  It's bulky, but the Stinger has  grown on me, because I can take it with me and chart wherever I am throughout the shift.  I can look at the patient while I chart his assessment.  I don't have to log into a new computer every time I want to chart a note or pass a med.  I don't have to go back to the desk and hope my memory will recall which arm his IV was in, or what time he developed SOB.

So I've been using the Stinger and trying to work it into my nightly routine.  The offgoing nurse frequently offers me a stationary computer "so you won't have to use a laptop," an accommodation I've taken to declining.  The nurses find my behavior mystifying.  My night colleagues get a charge out of seeing me push this thing up & down the halls, while they are tied to the desk.  

One drawback developed the other night when I brought the Stinger into a patient room, and the patient said in obvious irritation, "What the hell is that thing?"  "This," I said in my most winning tone, "is Molly the COW.  She's a Computer On Wheels."  (I made up the name on the spot.)  The patient, an alert 80-something, was singularly unimpressed but the explanation seemed to settle him down, and he allowed Molly to scan his ID band for a morning med.  I'm thinking of decking her with seasonal flowers or big stickers, to see how patients respond.  Valentine hearts coming up soon?

I especially like bringing Molly into the room for admission assessments because I can face the patient while asking 1,000 personal health questions, and chart it on the spot.  Done!  I imagine that one day we'll have the same capability in a computer the size of a Blackberry, but for now I consider Molly my best girlfriend.

Wild Ride Weekend

There was no warning, really, that this weekend was going to be wild, unless you count the number of shifts that had gone smoothly and were *almost* boring of late.  Naturally, something had to give.  

It gave an hour into the shift when the patient threw me out of their room and called for a hospital administrator.   It's the first time I've been accused of giving anyone a snippy answer.  Guess they didn't like my looks.  Their behavior became so outlandish that I had no idea what they might do next.  It turned out to be nothing but a fit of pique.  So that was a ridiculous episode; a tempest in a teapot.  After half a dozen phone calls and a supervisor visit, we traded patients and things settled down.

The second night started out with a pair of undertakers wheeling out the shrouded body of a patient who had passed at the end of the previous shift.  The patient's nurse had come on at 7, so she caught the squeal* on that one, and was looking a bit subdued.  

The night was going well, despite my several ill patients.  One was comatose, with a lot of loose chest congestion and an intermittent cough.  Another's vitals deteriorated every time they dozed off.  A third, with distention and edema, had just finished 2 units PRBC's.  I rounded often and made sure equipment was at the bedside just in case.  Then I gave a few meds and talked with the nurse whose patient had died.  

"Didn't you hear?" she said.  "I must be the angel of death.  That's the second patient that's gone out on me in a week."  "Well, you know how these things run in cycles," I said.  

We haven't had any deaths, or even very sick patients,  since New Years.  Just now we have a preponderance of very ill patients.   One of the many charms of a medical unit.  

It was now near morning.  The floor was quiet, and at that hour you can hear every sound on the floor from anywhere on the unit.  Which is how I was able to clearly hear someone call out my name, in the kind of voice that tells you something is wrong.   It wasn't a medical emergency; death is not an emergency for those who anticipate it.  The patient was simply gone from this life.  

Believe it or not, as many dying patients as I've had, I had never had one die abruptly.  This was a shock to the system.  Another visit from the supervisor.  God bless my co-workers, who prepared the patient to be seen by family, and did it before I could get off the phone with everyone who needed to be called.  The ride that night went on until a second pair of undertakers, this time wearing dark suits and overcoats, wheeled the shrouded patient away.  

We consoled one another, and stories were recounted.   The oncoming nurse, one with long experience on the unit, said she had seen seen many cases of abrupt death.  Even the float nurse had a story to tell.  I came home and had a stiff drink, and slept fitfully.

I just knew the third night was going to be either a bloody bore or something else bizarre.  I put in a foley, assessed four patients, gave two meds and two prn's for pain and then we had a minor staffing crisis.  The patient we had been told was coming from the ER did not materialize, and now we were overstaffed.  You know what that does to the budget.

So I was floated to the telemetry unit, where I had never been before.  I don't do telemetry, but after meeting Frick & Frack, the Stepdown Boys, I'm ready to learn.  I took report, did a bed check, ate some lunch sitting down, and later had time for a cup of coffee before doing a nurse lab draw and am meds.  I was actually able to sit down and eat without having a chart in my lap and a keyboard in my face!  What a great night!

*British slang meaning to take the call for an emergency.

Post-Holiday Slump

I hate the Grey Days of January & February.  We've been slow at work, too; people have been placed on-call and called off every day for the past two weeks, as if the patients themselves wanted to avoid going out.  Then it began to snow and suddenly the ER filled up and we admitted three patients overnight.  I'll never understand human behavior when it comes to hospitals and snow.  Did everyone wait to have the PNA/UTI/pancreatitis so they could be in hospital while it snowed?

The last snowstorm dumped 10-12 inches on us and the county authority is complaining bitterly about the cost of scraping and sanding the roads.  It's sleeting again so here comes more road mess.


The one bright spot has been floating to Ortho, where I was welcomed.  I found someone had created a full set of patient care protocols, which made the night go more smoothly than expected.  I actually enjoyed myself, pushing a Stinger portable computer into patient rooms to pass meds and chart assessments.  Even though it got busy at 0500, it was still a manageable shift.  I gathered some ideas I will use when back on my own unit.  Comparing my Ortho experience to the other unit, I observed how much more random detail is required on medical.   It's a wonder we ever get anything done.  When I see how far medical has to go before patient care will proceed smoothly, I am daunted. 

December 28, 2010

Last year on this day, Sweetie and I were shopping at a popular variety store in my old hometown when I got a call from the director of my Nurse Refresher program.   I had sent her an email just before Christmas, abandoning pride and throwing myself on her mercy.   

Find me a unit--anywhere--willing to take me for clinical experience, I begged.   My husband's company has been idle more than half this year and there are no projects on schedule for 2010.   I need to work!

She was not the person in charge of nurse placement, but she read my email and went to work trying to place me.   Now she was calling to tell me she had found a place for me at Li'l Old County General, 12 minutes from home; I should report the second week of January.   That phone call made my Christmas.  

A few of you may understand the chagrin I felt on visiting relatives, most of whom were healthy, happy, and well-paid while we were unemployed, broke, and putting on a good front.   I was glad for my family's success, but for me the hometown visit was too cruel a reminder of the years when we all had new clothes at Christmas, an obscene overabundance of gifts, and I was the Perfect Christmas Fairy.

2010 proved to be a year of adjustments and (Thanks be to God!) easing of financial worries.   We are in process of closing husband's company, a business into which we both put many hours of time and creative energy.   His client base has been demolished by the economy and work is so sporadic now that it doesn't make good sense to keep going.   Still, it is difficult to agree to label it DNR while there is any life left in the company.   I think at last we've agreed that "quality of life" for our company in this economy is impossible.   Pull the plug.  (sigh.)

Nursing work has made it possible for us to survive and prosper.   I didn't get a paying position until June, but Li'l Old County General has turned out to be a golden employer.  Along with decent working conditions, decent pay, and shift differential I got health insurance, sick leave, and chance for advancement.   These things are not (like husband's business) dependent on the whims of the wealthy.   Being a nurse makes it possible for me to stand on my own and provide for us while doing some earthly good.

Nobody is more surprised than I that nursing finally worked out.   Since I began in 1973, nursing seemed  an albatross of a job to me; I never felt fast enough or smart enough, and the shift work was a constant trial.   I left nursing three times, but fortunately I never lost my hard-won nurse sensibility.   The RN refresher course gave me a chance to demonstrate that my skills were not too rusted for use; forty years of varied life experience had made me a better nurse, too.

In the upcoming year I will grapple with my future in nursing; what direction will I take?  Informatics?  Chemotherapy certification?  RN to BSN to MSN?  Watch this space.

Gone to La-La Land

Apologies for months of no blog entries; Nurse Philosopher has been working a second job with Sweetie Husband which took a whole lot longer than anyone anticipated. 

We were elated when the project at La-La Land Care Center came through, failing to appreciate how it was strategically timed to fall athwart of every other plan we had for the next 60 days.  A few lessons learned: first, I'm not too old to burn the candle at both ends, but the flame meets in the middle a lot faster than it used to.  Second, I don't ever want to work in an Alzheimer's unit!  Just shoot me and send me to a place where patients don't pull on your leg while you're 4 feet up on a scaffold.  Third, when a worker doesn't show, you can call him and yell, but when you get the flu yourself, you're just SOL.  Last, I can personally attest to the reason-destroying properties of Christmas Muzak.  Work beneath a speaker pouring out Christmas drivel should be regulated by OSHA..  Heavily. 

Anyway, we send best wishes of the season to all the folks at La-La Land Care Center.  We're certain you can figure out where the gift deodorizers go.  Those small Christmas bags for the nurses contain earplugs; we hope they'll save the sanity of a nurse or two and help them cope with the continual din at La-La.  

Peace on Earth at last!

A Cast of Characters

No doubt you've noticed that patients are characters.  I have my favorites from over the years, like Hank,  an inpatient who went on to home care through an agency I worked for.  Patients are memorable for a variety of reasons, and are more likely to be remembered if they were somehow difficult to care for.  Hank was a head injury victim with altered mental status (AMS) and a persistent flat affect that made him very difficult to read.  Bunny, his devoted but high-strung wife, had depended on him for everything and tended to swoon every time it appeared he might not come home. 

In the months it took for Hank to recover from the head injury and subsequent surgeries, he progressed from being wildly confused through an episode of PE, to discharge home.  On the day we began to strongly suspect PE, Bunny demanded to know why Hank was having a new series of tests.  My simple but clinically correct answer sent her immediately over the edge.  The dismaying idea that Hank was suddenly sicker  burned like wildfire across her mind toward the thought Hank Might Not Make It Now!  She immediately got on the phone to his doctor with a thousand queries and demands, and Doc  pretty promptly got back to the floor wanting to know what idiot told her Hank's actual condition! 

Bunny was an over-imaginative hysteric, incapable of remembering the simplest directions.    Hank under optimal conditions was no prize.  After being reprimanded for informing the patient's family as I had been taught to do in nursing school, I came to dread caring for the both of them.  One night I brought Hank's hs meds and found him in bed watching tv.  As usual, he glanced at me with utter disinterest and said, "The w'm'n w'n."  Hmm?  "The woman won," he repeated.  (What woman?  What now?  Good heavens; was he experiencing dementia?  Elevated ICP?  This would just be frosting on the medical cake.)  Suddenly and to my great relief I saw that he had been watching Billie Jean King beat Bobby Riggs 3 out of 3.  Saved.

Despite all, Hank did go home.  I never cared for him at home, but the nurse who did reported great success in implementing Hank's post-hospital regimen.  She convinced Bunny that really effective home care begins with a martini before getting started.  Once the wife was calm, Hank made excellent progress.

AMS is a condition a person has to get a feel for.  I once cared for a petite, elderly lady with terminal cancer during her long, final, hospital stay.  Her one pleasure was smoking, and back in the day we allowed patients to smoke in their rooms as long as no O2 was going; the right to keep & use smoking materials was one of the last privileges to be withdrawn, and as I recall a doctor's order was necessary to do it.  One evening she asked me if I knew what "they" were planning to do with her, but when I questioned her she clammed up.  I was concerned, but later her disorientation seemed to have dissipated and I took no further action.

Her roommate was a pleasant, alert woman who had just come back from knee surgery and was bedbound  with a hemovac in place.  That night was to be my last on the unit--my transfer to another floor had come through--and when I heard screams from far down the hall after lights out I first thought it to be a farewell prank of the night staff.  Nevertheless, on approach I found eerie shadows of firelight flickering in the doorway of a patient room.  I rushed in to find the terrified knee surgery patient screaming for rescue and the elderly woman watching as if observing from a balcony while a blanket blazed nearby on her overbed table.   I called a Code Red, and floor staff appeared with looks of astonishment.  We unlocked bed wheels and pulled the nearly frantic knee patient quickly out into the hall, where she reported her roommate had intentionally lit the blanket with a cigarette lighter. 

The rest was a blur.  I recall pulling the old lady's bed away from the fire, leaving the blazing blanket for fire responders, who were pounding up the stairwell.  I checked her bedding for sparks and then pulled her bed out into the hall.  I burned my hand on the metal side rail, although it was 45 minutes before I actually felt the pain. 

Fortunately it was a small fire, despite the great mass of responders present from all over the hospital.  The hospital was run by Grey Nuns and one of the sisters who responded had psychiatric experience.  It was she who learned that the patient who started the blaze did so because she believed the hospital was to be auctioned off  tomorrow and her along with it.  The source of her AMS was found to be metastases to the brain.  I never took the things patients say quite so lightly after that...