Pressing On

In case you are new to this blog, I am a Pre-Op nurse. I am assigned on average 7 patients during my nine hour shift. My job is to do a physical assessment, a medication reconciliation, a health assessment and comb through their medical history with a fine tooth comb to find anything about their health history that may indicate the patient is not safe to go under anesthesia. I also educate patient and families, comfort them, medicate as needed, place IV access and give IV fluids. It’s fast paced and mental. Some patients come for elective surgery. Some come because their lives depend on it. Lots of sick people for me this week. Today was particularly difficult. Everyone’s life depended on their surgery today. To top it off, in the middle of the day, one of my coworkers was notified of a death in her family. She had to leave immediately. Those of us that remained just pushed on as if we were soldiers on a battlefield, pulling our own casualties to safety and pressing on to fight the terrible war against death. The day dragged on and on with hard IV sticks, complicated medical histories, and unexpected additional tasks.

When I sat in my car to go home, I realized that I had not yet processed the death of my coworker’s parent. Despite our busy start, we’d spent the beginning of our morning laughing, teasing each other and bickering as we always do when we are assigned in the same area. Now the flow of her life has changed and I am sad for her.

Towards the end of the day I was getting some negative vibes from a patient. I felt like she and her husband didn’t like me. Maybe I just sounded too systematic to her or too routine. Maybe it’s my imagination. Maybe she was too worried about her condition to appear friendly. She was assigned to me as fast as my coworker ran out the door. I was hypoglycemic and in shock over my coworker’s loss. Yet I pressed on as best I could, because I am a nurse.

The Other Side of the Equation

The operating room staff gave my husband and I paper gowns and allowed us to accompany our daughter into the operating room. I stood aside and watched them take over and prepare her for the procedure. Everyone had their role and they identified what their roles were. They were a well oiled machine. They made sure she was comfortable on the operating room table and explained things as they went along. They placed monitor leads on her chest to monitor her heart during the procedure. The anesthesiologist prepared her equipment and drew up the white medication in the syringe that was going to be used to sedate my daughter. She asked my daughter where she’d be traveling in her dreams today and my daughter replied, “Italy”. Everyone in the room agreed Italy would be an excellent place to go in an anesthesia dream. The anesthesiologist pushed the medication into my daughters iv and placed the mask on her face simultaneously. Within seconds she was asleep and I knew my daughter’s life was now in their hands. I kissed her forehead and backed away from the operating table so I could be escorted out of the room. I remember everything that happened today vividly but the thing I remember most is my daughter’s clear blue eyes, going to sleep with anesthesia.

Fortunately it’s not often, but for once I was on the other side of the health care equation. Instead of someone putting their loved ones life in my hands, I was putting my loved one’s life in someone else’s hands. I was critically ill when I had my son. I was in the hospital for a week during that time. On my sickest day, I absolutely couldn’t stand the nurse that took care of me. She was mean. Thirteen months after he was born I transferred to the Emergency Room. My own experience of being critically ill and being taken care of by a person who had no business in a field where compassion is requirement, not an option, taught me to reassure my critically ill patients that things are going to move quickly but I am here, I will not leave them, I will tell them everything we are going to do and that I will take good care of them.

I am a preop nurse. I knew what to expect today. I wasn’t afraid. I simply knew my baby was going to be well taken care of. The staff demonstrated that to me through their knowledge, skills and compassion immediately. As a preop nurse who’s now just sent their child into surgery under general anesthesia, I can now empathize how my patients and their families are feeling on the day of surgery. It’s beneficial for health care workers to have experiences like this. Being on the other side of the health care equation helps us understand and empathize so we can do our jobs better.

30 Day Writing Challenge Day 2

Okay cool, the blogger I follow who’s doing a 30 Day Writing Challenge has posted Day 2’s question: Write something that someone told you about yourself that you have never forgotten.

Here we go. Circa 1997 I was a few years out of nursing school and working on a coronary progressive care unit. I was taking care of a little lady who I’d taken care of frequently. I enjoyed taking care of her. Her condition caused her to tire easily and she always needed help with her ADL’s-Activities of Daily Living. Helping patients with their ADL’s was always a perfect time to talk to them, get to know them and tidy up their rooms. So I helped her bathe and afterwards I helped her walk to a chair so she could sit while I made her bed. As I helped her back into bed she looked me in the eyes and said, “I was talking to Jesus about you the other day. We agreed that you have a gift, you don’t know you have. You need to figure it out”.  My little newly wed 27 year old self told her that my husband and I were hoping to soon start a family, maybe the gift was me being a good mother. She said, “you’ll be a mother soon but that’s not it. Think about it”. I couldn’t wait to talk to her about it more but I got busy the rest of the day and I didn’t see her after that. I later learned that she’d passed away at home.

Those moments with that patient and that conversation will live in my memory forever. I remember what the hospital room looked like and I remember what room and bed she was in during that admission. I remember her face. The image of me bathing her, making her bed and talking to her is still there. The image of her looking into my eyes to tell me about my gift still there. For awhile I racked my brains trying to figure out what the gift is. I know in due time it will present itself. If the gift is being a writer, I’ll dedicate my first book to her.

Why Nurses Do What They Do

Several years ago, the week before Christmas, I entered the nurses station at 0700 in the Emergency Department I worked in for morning report. As I did every morning, I scanned  the patient tracking screen to look at how many patients we had and if I recognized any familiar names. I spotted a patient who I’d taken care of multiple times and who I enjoyed taking care of. Naturally, I jumped at the opportunity to take care of him again. I asked the night shift nurse for report and looked forward to entering his room.

I quickly learned that my patient was not doing well. The doctors suspected that he was now in the terminal phase of his illness. Through the course of the eight hours I took care of him, even after I’d infused over three liters of IV fluid and transfused two units of packed red blood cells, I could not control his pain or keep his blood pressure stable enough to give pain medication and he was beginning to display signs of organ system failure. I spent hours in that room that day not only caring for him, but helping his wife accept what was happening.  After I transported him to intensive care and helped him get comfortable in his bed, I put my hand on his, got close to his face, looked him in the eyes and told him to take care. Our eyes were locked for several seconds. He said thank you and wished me well. He died twelve hours after I transported him to intensive care and I still relive looking into his eyes for the last time.

The holiday season isn’t an easy one for nurses. Not because we work long hours, sacrifice and miss our own holiday gatherings to care for others. Because we see how illness impacts people’s lives. To be present to watch patients and their families experience these things on the holidays leaves a long lasting effect on healthcare workers. Why?  Because we see the look of desperation in our patient’s eyes where we know they are wondering if this illness is going to pass, be chronic or even life threatening. We observe families trying to be brave for their sick loved ones when we know they are afraid. We hear the screams from the room where the cardiac arrest was just pronounced dead. We see the look of fear as our surgical patients are being wheeled to the operating room with all evidence of the human being they are having been stripped away from them and replaced by a hospital gown, colorful footies and a warm blanket. We walk through the surgical waiting area and see the blank stares of families as they wait for a surgeon to come out and tell them if their loved one has cancer. We try to do everything we can to cheer up our inpatients when they are stuck eating hospital turkey on Christmas day or can’t eat at all because they are too sick. We observe our Dementia patients roaming the halls of the long term care facilities and wonder what they were like before Dementia robbed them of their memory. We thank God profusely that our own loved ones are healthy and waiting for us to come home. Our shifts end and we go home, shower and try to shake it off. Deep down inside, over the years memories similar to the one I shared resurface for all of us.

The brightness and warmth of the summer sun replaces the darkness of December and the months fly by. Six months after my patient passed away, I’m at work one summer afternoon and I hear my name being called from across the ER. I turn around an realize it’s my patient’s wife. She quickly walks up the me, hugs me and tells me she’s doing fine. She’d just been the see a chaplain whom she was seeing monthly. She said she’d come down to the ER to specifically find me and tell me how she was doing and to say thank you. I was so moved by that I rushed right up to one of my good buddy coworkers to tell her. Her response was simple, powerful and true, “This is why we do what we do”.

 

Why Adult?

Why adult when you can go hiking? I am hiking as we speak. I am sitting in the woods on a log as I draft this in my journal. A lady and her two dogs just passed by me on the trail. She gave me a puzzled look as if she wondered why I was sitting on a log writing in a notebook. Hasn’t she ever seen a writer trying to get her thoughts on paper?

Aside from a few minor annoyances at work Monday and Tuesday, I’m having a decent week so far. Monday afternoon my surgeon was running two hours behind. As I walked down the hall past my patient’s room on my way to the desk I heard my patient’s simple assed family member summon me. “HEY MISS, she’s hungry when is the surgery”. I froze. I felt as if I was in a torture chamber room listening to someone repeatedly scrape their fingernails down a chalkboard. I despise being called miss really I do. I closed my eyes, took a deep breath and turned around to walk into the room. “Nurse, you mean”, I replied. Now I know that woman knows I’m a nurse because I introduced myself as her daughter’s nurse when I went to the waiting room to retrieve her. I apologized to the patient for the delay and explained the situation, which I had no control over. I turned around and left the room having felt like all of the empathy had been sucked out.

Yesterday I was pulled to a preop unit to preop the patients of a surgeon who’s types of patients I simply don’t enjoy taking care of. Unfortunately while I was at lunch, one of my coworkers was screamed at by my patient’s mother, demanding pain medication for her son as he demonstrated drug seeking behavior. So the surgeon came to consent the patient, I got a pain medication order for something “extra stronger” than he takes at home and all was right in their world, but not in mine. Sometimes even something as small as being called “miss” and being yelled at by a drug seeker take their toll on a nurse’s humanity.

So here I am in the woods on my day off. I have adulting to do today but it’s going to have to wait until being in the woods has cleared my head and re-energized me. I’ll be busy this evening and tomorrow evening with something at my daughter’s school. If it doesn’t get done today, it wasn’t meant to be. With one kid in college marching band and the other kid in high school marching band I make it a top priority to hit the trail during my weekdays off because there’s no guarantee I’m going to have time on the weekends in the fall.

My husband and I look forward to hiking longer and different trails in the future but right now it will have to wait. My daughter is a freshman in high school and in her first year of marching band. It has been a thrill to see the experience and all of the firsts through her eyes. Her beautiful clear blue eyes that look as blue as a Caribbean Sea when she puts on that navy blue uniform. She’s so happy and we are at her marching band events, we are there with her, in the now and not on the trail.

The Appalachian Trail continues to call for us and remains part of our subconscious minds though. Whether it be day hike, a section hike or a thru hike, we want it all. We do research, read trail journals and I’ve read several books about people who have thru hiked. Now is not the time for us to thru hike but we will have time to section hike soon. Our kids need us. It’s ok.

On a positive note, I’ve learned a few things about myself as a hiker. I’ve learned that I need to eat and hydrate after each three miles I hike. I’m learning to use a compass. I’ve learned that I can carry more weight on my back than I originally thought I could. I’ve learned to follow a trail alone and how to find the trail again if I wander off trail to look at something. I’ve learned to hike my hike and enjoy my hike. I try so hard to let time limits go when I am in the woods. When I leave the woods my mind is in a much happier place.

 

 

 

On August 12

August 12, 2016: I have a weekday off and I am out to lunch with my kids. I enjoy taking them out for lunch when they are on summer break. I look across the table at my son. He wears a goatee on his chin and the rest of his face has several day stubble of beard. He looks like a man now. His serious brown eyes tell me differently though for they are still the eyes my little boy. I know what’s going on in his head because it’s the same thing that went on in my head 25 years ago. It occurs to me that soon I won’t be able to enter his bedroom at 0530 each morning to kiss his forehead before I leave for work. On this day, August 12, 2016 I know that I have approximately ten days to finish dorm room shopping, help him order his college books and get my emotions in check. He’s leaving for college.

Rewind my life back by twenty five years to August 12, 1991. I was weeks away from my 21st birthday and my mother was preparing for my departure. I couldn’t write about this on August 12, 2016 though. Too many emotions involved. Today I can.

At 0700 we stepped off the elevator onto a medical-surgical floor. The aroma of night time body odor, cheap hospital soap and powdered eggs greeted us for the first time in our lives. I immediately gagged at the odor and wondered if I’d made the right choice. We checked in at the nurses station and got our patient assignment. Our task for the day: to administer a bed bath.  I knocked on my patient’s door and there was no answer so I walked in. My patient was sitting up in bed with a sheet over her head as if she were a dead body covered up. I backed out of the room with eyes wide open to show one of my classmates and get the attention of my instructor. My instructor and I went in the room together. My patient was a little old lady with dementia. My instructor helped me bathe her. This lady incredibly was strong. She was combative and she kicked my ass during that bed bath.  I remember noticing how easy interacting with the patient during the bath seemed for my instructor and hoped that one day I could enter a patient’s room with that much confidence. I never saw that patient again but I’ll never forget her either.

I remember so many firsts during that time of my life. I remember when they taught us how to do the hospital tuck but I was proud because I already knew the hospital tuck way of making beds because me grandmother taught it to me as a little girl. I remember the first patient I became attached to. I remember the first time I saw a baby being born and the first time I realized one of my patients was deteriorating over a period of several days and was going to die. I remember my first cardiac arrest and how scared I was. I remember the first time I saw the cardiac rhythm Atrial Fibrillation on a telemetry monitor. It’s not the most lethal rhythm but a dangerous one if uncontrolled. I remember the first time I suctioned someone through their tracheostomy and how when the patient coughed the “trach cough” that it startled me so badly I jumped. I remember calling my mom at work to tell her that I’d given my first blood transfusion and how she yelled out to her coworkers, “my daughter just gave a blood transfusion today”. I remember my first AIDS patient and how his family turned their backs on him because he was gay and dying of AIDS and that he died alone. I remember hearing helicopters and sirens at all times of the night because I lived in the dorm next to the hospital. I remember the oxford blue shirts, white pants, white socks and shoes we had to wear. By graduation those oxford blue shirts had pit stains on them from all the blood sweat and tears we’d put into this. I remember two nursing instructors that were tough as nails to me because I was a young smart ass and I deserved the torture they put me through.They turned the light bulb on in my head and taught me to look at the bigger picture, the patient as a whole. After that I was ready. I remember after each clinical day in the hospital, I’d hum the MASH theme song to myself because I’d helped people just like those nurses did.

I remember how it felt to hold my nursing pin in my hand for the first time on May 14, 1994, the day I graduated Nursing School. I remember coming home from errands on July 18, 1994. My brother was holding a thin envelope addressed to me from the Missouri Board of Nursing notifying me that I had passed my state boards. I was now a Registered Nurse. I remember sitting for my Board Certified Emergency Nurse exam and having a panic attack because I thought I was going to fail that exam. I passed the exam. I remember walking across the stage on May 28, 2011 to receive my Bachelor of Science in Nursing degree.

I remember August 12, 1991 alright. It was my first day of Nursing School. The day all of the above began for me. Never forget what you’ve earned and what you went through to get it.

 

I am a Nurse. That’s what I do.

I am a PREOP nurse. Four days per week between Monday-Friday, I rise at 0430, put on the scrubs and drive my jeep at warp speed so I can begin my 0600-1530 work day. I prepare patients for surgery.

Two weeks ago, my hospital opened up a surgical unit for Orthopedics. All of the Orthopedic surgeries now go through PREOP/OR/PACU on their own floor. Today I got pulled to the Orthopedic Surgical Unit. It was my first shift there. I had a wtf moment when I saw my assignment: 0830, 0840, 0850, 0910, 1140, 1250. These patients had multiple health problems, were on a ton of medications, could barely walk and a few were hard IV sticks. The surgeon I worked with often moves fast and runs ahead. The orthopedic OR staff is also a little impatient. I felt like I’d been hit by a train. On top of it, here I was getting used to a new unit for the first time. Different geography, newer equipment and a different unit flow. At one point one of my charts fell apart because I was so frazzled I forgot to close the three ring binder before I closed the chart. I felt like a new grad today. Somehow I managed to get through it all without being removed in a straight jacket. My patients went to surgery safely and on time. The surgeon didn’t yell at me and after my first four patients I could finally exhale. I did it because I am a nurse and that’s what I do.

My husband is not a nurse but today he had to report to work at 0600, two and a half hours earlier than usual because of an extremely busy day for his department. Today at 2;46PM my husband sent me a text stating that he needed a nap. I told him to welcome to my Monday-Friday weekly sleep deprived trance. He said he didn’t know how I managed to get up at 0430 every day. My answer is simple. I am a nurse and that’s that I do.

On July 20, in my Social Media post, I mentioned a dying coworker. Four days later on July 24, she passed away in the early evening. Less than 12 hours later, I was back at work at 0600. I went through the motions of my work day, double checking my work because it was difficult to concentrate. I took good care of my patients. I reassured them their surgeries would turn out fine. I smiled. Behind my smile though was a broken heart for the loss of a good nurse that I’d worked closely with when she and I worked together in the Emergency Room. I had less than 12 hours after her death to get to bed, have a terrible night’s sleep and get to work to take care of my patients without any free time to take a moment to reflect upon her life and the purpose she had in mine. Nurses don’t get the luxury of putting our work on pause. We get a grip and just keep moving. All the time. I am a nurse and that is what I do.

When Social Media is too much

Recently, one of my former coworkers made the decision to be placed in home hospice after treatment complications from a long illness. Through the course of her illness, she followed all the rules, took care of herself during treatment, kept a positive attitude and fought a very brave battle. Unfortunately she was told all treatment options have been exhausted. Instead of seeking additional medical opinions and miracle cures, she of sound mind, with her family’s support, made the decision to die.

She’s had an outpouring of support from family, friends and coworkers on social media. There’s pictures, memories, social functions and good times mentioned. While some choose to publicly support her, others choose to hold a silent vigil everyday for her in their hearts. I am in disagreement with some of these social media posts because some refer to her “fighting the disease” when she has clearly made a decision to die. It is even more disturbing that a few of these people who are encouraging her to “fight” are health care providers who know the reality of her disease and should know better than telling a dying woman to fight when there is no hope.

One of the most valuable things I’ve learned as a registered nurse didn’t come out of a textbook or in a nursing skills lab. It happened in real life at the bedside and more than once. When a someone tells you they want to die, as painful and difficult as it is, we must accept their wishes and let them go. Denial, anger, bargaining, depression and acceptance are all part of the grieving process but sometimes we as healthcare providers don’t have time for all parts of the grieving process until later. Sometimes out of respect for the dying we have to jump right on to acceptance and deal with the other stages on our own time.

Where have people’s morals and integrity gone? Where do we draw the line with our egos on  what is appropriate to post on social media? What do we hope to gain by telling a dying woman to fight when she’s decided to throw in the towel because there’s no hope for her? Why do these people think they have to be “the one” for this woman? I am one of those who have held a quiet vigil for her everyday in my heart and I’m ok with that. I have happy memories of good times at work with her and lunch dates with good food.  I will hold them dear. I accept her wish.

The Truth Behind July 1.

Becoming a nurse was by far the hardest thing I’ve ever done in my life. The memorizing and understanding of material and the hours of study and preparing for clinical were grueling. Not to mention the social lives of all student nurses fly right out the window the minute the first course begins. No, I can’t go to your party. I can’t be hungover because I have clinical at 0700. I have to be on top of my game. I’m taking care of someone’s loved one.

My nursing instructors were scary and mean and did not except sub par performance in the classroom or clinical area. I remember two of them in particular. One of them was a retired navy nurse. Tough as nails. The other one reminds me of the female version of Professor Snape from Harry Potter. They were relentless but they had to be that way. They were teaching us to save lives.

One very important thing they taught us is how to provide safe and effective nursing care which ultimately keeps us out of a courtroom. If the nurse receives a physician order that the nurse feels is written incorrectly, wrong or unsafe, the nurse must question the order immediately. Do not pass go. Do not carry the order out. Question the order. Clarify. Call the attending physician. Do whatever you have to do. Just don’t do that order.

Translation: IF the order is wrong and the nurse carries the order out and the patient is injured or has an adverse reaction, the nurse’s ass will fry. I repeat, in a court of law, the nurse’s ass will fry.

As a student nurse, I worked as a Unit Secretary on an acute medicine/telemetry floor throughout school. The things I learned were priceless. Part of my job was  to put physician orders in the computer so the nurses could carry them out. I learned how to interpret a physician’s messy handwriting quickly and I was never afraid to use the hospital computer system and I’m still not afraid to. I learned how to navigate my way through a chart and use the telephone to collaborate with other units. I learned about roles of other health care providers; respiratory therapists, physical therapists, occupational therapists, nurse techs, dieticians and how the unit flows throughout the shift.

I listened too. I listened to what the nurses on the floor said about just about anything. I could never figure out why this one nurse in particular was always on vacation for the first three weeks of July every year. So I finally asked her. Her answer was simple and her message rang loud and clear. “Because July 1 is the day the new interns fresh out of medical school start. It’s chaotic and I don’t want to be around the first few weeks of it”.

July 1 is the day the new interns begin. They’ve graduated medical school and earned the title of MD. They’ve been matched with the hospital that they will do the residency of their specialty at. They are green as could be and now they are being let out into the world of healthcare. Now mind you, interns and residents have to discuss their treatment plan with an attending physician before implementing it but that still puts nurses on high alert during those first few weeks especially on the inpatient units, ICU and Emergency.

Listen to the voice in your head especially on July 1. The one that says there’s something wrong with this order. If the voice in your head says don’t carry the order out and get that intern over here, listen. Don’t carry out that order. You will fry. Also, try not to scare the intern too badly. Not on the first day at least. They are just starting out on their journey of savings lives just like you did.

 

 

When it Hits Home

As health care workers, we witness tragedy, illness and death on a daily basis. We learn to cope with it, block it out, shake it off and “Just keep swimming” as Dory the fish would say. Each day as we walk out of the hospital at the end of our shifts, we step into that imaginary phone booth to twist around and shed our super life saver cloths. No one will ever know what we’ve experienced during our work day if we don’t want them to.

In the hospital I work in as a nurse, we refer to each other as family. There’s the hospital wide family and there’s the unit where you work family. Regardless of a person’s job description, we have one common goal: to save lives. We celebrate holidays together. We pass each other in the halls, we chat about our lives, and we share joy and sorrow.

Unfortunately, I’ve experienced illness and death on multiple occasions among my coworkers in my 22 years as a nurse. It doesn’t get any easier as the years pass, as we get older, knowing what we know about life and death.

Monday morning, my unit family learned that an employee in a unit that we work in conjunction with every day had a medical emergency over the weekend. Although they were still alive, the outlook did not look good. The hospital family held a prayer service. This employee’s unit family held a prayer breakfast. A Go Fund Me account was set up.

Early yesterday morning we learned that this member of our hospital family was placed in hospice. After learning this, I took some time to reflect and pray for this person. I didn’t know this person as well as I know others but she always smiled and nodded at me in passing.  I thought about her in her street cloths and not her super life saver uniform,  as the human being that she is outside of the hospital, how full of life she was prior to this illness and how sad her family must be.

As I went along with my day yesterday I had that familiar feeling in my gut that I often do when something is wrong. I couldn’t put my finger on it but I was sad. I’d gone out for a random lunch with a friend, ran errands, cleaned up my house and took a nap. It was a good day. Then I figured it out.  I’d just kept swimming after learning about my coworker in hospice. I thought I could just reflect, say a prayer and shake it off because that’s how we are programmed so we don’t go crazy. Not this time. I didn’t have my super life saving uniform on. It made me feel vulnerable. I realized that I would never see this coworker again and it hurt.

I woke up this morning and knew that I had to write this post for my coworker, for anyone who’s ever lost a coworker, and for the non medical world to understand how much it hits home when we lose one of our own. Later this afternoon I learned that God has taken my coworker home. May she rest in peace.

 

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